| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
587 |
585 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
850 |
847 |
$17K |
| D1110 |
Prophylaxis - adult |
447 |
445 |
$16K |
| D9920 |
|
543 |
534 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
491 |
490 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
246 |
243 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
856 |
854 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
744 |
738 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
81 |
$3K |
| D0602 |
|
295 |
292 |
$2K |
| D0274 |
Bitewings - four radiographic images |
425 |
417 |
$2K |
| D0272 |
Bitewings - two radiographic images |
304 |
297 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$585.00 |
| D0601 |
|
20 |
20 |
$140.00 |
| D1330 |
|
1,282 |
1,189 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
90 |
89 |
$0.00 |