| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
513 |
508 |
$14K |
| D1120 |
Prophylaxis - child |
244 |
243 |
$9K |
| D1110 |
Prophylaxis - adult |
134 |
132 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
591 |
463 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
433 |
429 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
517 |
510 |
$6K |
| D0274 |
Bitewings - four radiographic images |
161 |
159 |
$4K |
| D1206 |
Topical application of fluoride varnish |
182 |
181 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0603 |
|
50 |
49 |
$0.00 |
| D0601 |
|
68 |
68 |
$0.00 |
| D0602 |
|
38 |
38 |
$0.00 |