| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
925 |
922 |
$15K |
| D4346 |
|
395 |
392 |
$12K |
| D1206 |
Topical application of fluoride varnish |
699 |
695 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
991 |
962 |
$5K |
| D1120 |
Prophylaxis - child |
291 |
290 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,111 |
1,052 |
$4K |
| D9920 |
|
316 |
291 |
$4K |
| D0274 |
Bitewings - four radiographic images |
487 |
486 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
124 |
124 |
$3K |
| D1351 |
Sealant - per tooth |
310 |
61 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
169 |
149 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
110 |
100 |
$2K |
| D0601 |
|
194 |
191 |
$2K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$443.00 |
| D9210 |
|
17 |
14 |
$89.00 |