| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,402 |
2,321 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,585 |
2,520 |
$76K |
| D1120 |
Prophylaxis - child |
1,499 |
1,466 |
$76K |
| D1110 |
Prophylaxis - adult |
1,097 |
1,031 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
1,604 |
1,532 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,411 |
1,332 |
$26K |
| D0272 |
Bitewings - two radiographic images |
410 |
404 |
$15K |
| D0274 |
Bitewings - four radiographic images |
179 |
172 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
77 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
39 |
$1K |
| D0601 |
|
2,363 |
2,306 |
$0.00 |
| D1330 |
|
191 |
180 |
$0.00 |