| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
739 |
734 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,438 |
914 |
$15K |
| D1120 |
Prophylaxis - child |
419 |
418 |
$15K |
| D1110 |
Prophylaxis - adult |
267 |
261 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
903 |
895 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,004 |
979 |
$11K |
| D0274 |
Bitewings - four radiographic images |
323 |
313 |
$10K |
| D0272 |
Bitewings - two radiographic images |
138 |
136 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$918.32 |
| D0603 |
|
1,143 |
1,110 |
$0.00 |