| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
492 |
468 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
484 |
459 |
$12K |
| D1120 |
Prophylaxis - child |
543 |
516 |
$11K |
| D1206 |
Topical application of fluoride varnish |
519 |
492 |
$11K |
| D9999 |
Unspecified adjunctive procedure, by report |
388 |
368 |
$9K |
| D0272 |
Bitewings - two radiographic images |
339 |
322 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
67 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
148 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
116 |
$260.70 |