| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,153 |
2,024 |
$226.10 |
| D0220 |
Intraoral - periapical first radiographic image |
2,703 |
2,483 |
$121.14 |
| D1120 |
Prophylaxis - child |
2,362 |
2,241 |
$80.00 |
| D1206 |
Topical application of fluoride varnish |
1,557 |
1,461 |
$57.00 |
| D0272 |
Bitewings - two radiographic images |
1,774 |
1,685 |
$46.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
243 |
234 |
$30.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,988 |
2,316 |
$30.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,912 |
1,809 |
$19.00 |
| D1110 |
Prophylaxis - adult |
734 |
684 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
66 |
61 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,170 |
1,111 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
683 |
641 |
$0.00 |