| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,435 |
1,262 |
$32K |
| D1110 |
Prophylaxis - adult |
739 |
635 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,416 |
589 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
892 |
758 |
$11K |
| D1120 |
Prophylaxis - child |
459 |
406 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
800 |
627 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
114 |
$5K |
| D0274 |
Bitewings - four radiographic images |
187 |
142 |
$4K |
| D1206 |
Topical application of fluoride varnish |
183 |
158 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
28 |
$904.38 |
| D0272 |
Bitewings - two radiographic images |
15 |
12 |
$232.20 |
| D1999 |
|
74 |
47 |
$0.00 |