| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
566 |
538 |
$13K |
| D1206 |
Topical application of fluoride varnish |
444 |
417 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
498 |
462 |
$6K |
| D1110 |
Prophylaxis - adult |
133 |
124 |
$4K |
| D1999 |
|
139 |
114 |
$2K |
| D1120 |
Prophylaxis - child |
64 |
58 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
117 |
$1K |
| D0274 |
Bitewings - four radiographic images |
93 |
84 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
47 |
$938.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
120 |
115 |
$261.33 |
| D0602 |
|
631 |
593 |
$0.00 |
| D9912 |
|
46 |
45 |
$0.00 |