| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,136 |
838 |
$28K |
| D1120 |
Prophylaxis - child |
1,474 |
1,092 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,085 |
916 |
$19K |
| D0272 |
Bitewings - two radiographic images |
283 |
244 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$407.30 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
28 |
$344.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
77 |
38 |
$200.40 |
| D0120 |
Periodic oral evaluation - established patient |
30 |
17 |
$28.50 |
| D1999 |
|
330 |
247 |
$0.00 |