| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
334 |
287 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
963 |
345 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
328 |
275 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
376 |
$4K |
| D0272 |
Bitewings - two radiographic images |
164 |
136 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
222 |
189 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
56 |
$2K |
| D1206 |
Topical application of fluoride varnish |
53 |
47 |
$676.20 |
| D0603 |
|
494 |
437 |
$0.00 |