| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
349 |
325 |
$9K |
| D1120 |
Prophylaxis - child |
200 |
187 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
299 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
196 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
247 |
163 |
$2K |
| D1206 |
Topical application of fluoride varnish |
193 |
178 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
25 |
$883.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
27 |
$607.88 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$603.68 |
| D0603 |
|
503 |
478 |
$0.00 |