| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
986 |
982 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
126 |
125 |
$17K |
| D0240 |
|
1,964 |
942 |
$16K |
| D1120 |
Prophylaxis - child |
445 |
444 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,048 |
1,046 |
$14K |
| D0272 |
Bitewings - two radiographic images |
291 |
290 |
$6K |
| D1110 |
Prophylaxis - adult |
113 |
113 |
$6K |
| D0274 |
Bitewings - four radiographic images |
172 |
172 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$918.32 |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
97 |
$796.47 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
67 |
$434.39 |
| D1330 |
|
108 |
107 |
$299.75 |
| D0601 |
|
1,033 |
1,025 |
$0.06 |
| D0602 |
|
13 |
13 |
$0.00 |