| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
283 |
278 |
$8K |
| D1110 |
Prophylaxis - adult |
137 |
134 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$6K |
| D0272 |
Bitewings - two radiographic images |
220 |
218 |
$5K |
| D1120 |
Prophylaxis - child |
144 |
142 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
306 |
301 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
227 |
225 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
217 |
192 |
$2K |
| D0330 |
Panoramic radiographic image |
55 |
55 |
$2K |
| D0601 |
|
325 |
323 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |