| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,499 |
1,496 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
856 |
854 |
$20K |
| D1110 |
Prophylaxis - adult |
567 |
564 |
$17K |
| D1120 |
Prophylaxis - child |
838 |
832 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
728 |
720 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,037 |
1,036 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
663 |
654 |
$3K |
| D1206 |
Topical application of fluoride varnish |
193 |
193 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
446 |
284 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
39 |
$339.36 |