| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
753 |
746 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,512 |
926 |
$19K |
| D1120 |
Prophylaxis - child |
363 |
357 |
$11K |
| D0272 |
Bitewings - two radiographic images |
652 |
643 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
240 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$2K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
62 |
$636.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$503.00 |