| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
1,672 |
1,635 |
$48K |
| D1120 |
Prophylaxis - child |
2,020 |
1,979 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,538 |
1,509 |
$46K |
| D1206 |
Topical application of fluoride varnish |
609 |
601 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
297 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
139 |
$1K |
| D0272 |
Bitewings - two radiographic images |
84 |
84 |
$851.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
128 |
61 |
$300.99 |
| D0240 |
|
26 |
16 |
$231.66 |