| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
651 |
621 |
$18K |
| D1120 |
Prophylaxis - child |
453 |
431 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
817 |
779 |
$11K |
| D0274 |
Bitewings - four radiographic images |
459 |
441 |
$11K |
| D1110 |
Prophylaxis - adult |
162 |
153 |
$7K |
| D0272 |
Bitewings - two radiographic images |
186 |
182 |
$4K |
| D0330 |
Panoramic radiographic image |
41 |
39 |
$880.48 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
26 |
$879.47 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
28 |
$327.01 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
12 |
$230.20 |
| D0601 |
|
468 |
453 |
$0.00 |
| D0602 |
|
130 |
125 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |