| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,656 |
2,635 |
$143K |
| D1120 |
Prophylaxis - child |
3,312 |
3,286 |
$124K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,322 |
3,295 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,831 |
1,815 |
$38K |
| D1351 |
Sealant - per tooth |
1,510 |
427 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,161 |
2,970 |
$24K |
| D0272 |
Bitewings - two radiographic images |
476 |
469 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
70 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
25 |
$312.00 |