| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
618 |
616 |
$17K |
| D1206 |
Topical application of fluoride varnish |
528 |
525 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
682 |
645 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
235 |
222 |
$8K |
| D1110 |
Prophylaxis - adult |
147 |
145 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
752 |
617 |
$6K |
| D1120 |
Prophylaxis - child |
88 |
88 |
$4K |
| D0274 |
Bitewings - four radiographic images |
117 |
116 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
79 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
159 |
158 |
$3K |
| D1330 |
|
124 |
121 |
$794.76 |
| D0603 |
|
75 |
75 |
$649.84 |
| D0180 |
|
13 |
13 |
$546.00 |
| D1999 |
|
29 |
21 |
$196.00 |
| D1310 |
|
14 |
12 |
$0.00 |