| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
910 |
896 |
$13K |
| D9999 |
Unspecified adjunctive procedure, by report |
85 |
85 |
$10K |
| D1110 |
Prophylaxis - adult |
221 |
220 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
237 |
233 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
546 |
351 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
119 |
$2K |
| D1120 |
Prophylaxis - child |
98 |
96 |
$2K |
| D0272 |
Bitewings - two radiographic images |
252 |
249 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$388.00 |
| D1999 |
|
171 |
158 |
$200.00 |