| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
983 |
956 |
$50K |
| D1351 |
Sealant - per tooth |
1,772 |
272 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,122 |
1,892 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,418 |
1,363 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,106 |
1,077 |
$36K |
| D1120 |
Prophylaxis - child |
863 |
826 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,116 |
2,034 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,124 |
1,096 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
106 |
102 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
315 |
306 |
$10K |
| D0272 |
Bitewings - two radiographic images |
422 |
401 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
656 |
621 |
$9K |
| D0601 |
|
293 |
282 |
$0.00 |
| D0602 |
|
1,811 |
1,750 |
$0.00 |
| D0603 |
|
16 |
16 |
$0.00 |