| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
328 |
321 |
$9K |
| D1120 |
Prophylaxis - child |
240 |
233 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
507 |
493 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
499 |
268 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
291 |
$4K |
| D0274 |
Bitewings - four radiographic images |
77 |
73 |
$2K |
| D1351 |
Sealant - per tooth |
77 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
37 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$647.58 |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$607.88 |
| D0603 |
|
392 |
386 |
$5.00 |
| D0601 |
|
132 |
132 |
$0.00 |