| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,250 |
1,250 |
$36K |
| D1120 |
Prophylaxis - child |
762 |
762 |
$20K |
| D0272 |
Bitewings - two radiographic images |
879 |
879 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,804 |
1,056 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,230 |
1,230 |
$12K |
| D0330 |
Panoramic radiographic image |
119 |
119 |
$6K |
| D1110 |
Prophylaxis - adult |
116 |
116 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
77 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
55 |
51 |
$600.60 |
| D9985 |
|
263 |
209 |
$0.00 |