| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
264 |
256 |
$32K |
| D1120 |
Prophylaxis - child |
578 |
534 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,790 |
629 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
233 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
282 |
274 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
744 |
670 |
$6K |
| D0272 |
Bitewings - two radiographic images |
365 |
340 |
$6K |
| D1206 |
Topical application of fluoride varnish |
270 |
256 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
240 |
230 |
$3K |
| D1110 |
Prophylaxis - adult |
27 |
26 |
$1K |
| D0274 |
Bitewings - four radiographic images |
15 |
14 |
$308.03 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$228.41 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$206.58 |
| D0603 |
|
1,164 |
1,100 |
$0.00 |