| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,892 |
13,844 |
$479K |
| D0120 |
Periodic oral evaluation - established patient |
13,538 |
13,492 |
$337K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,367 |
13,318 |
$284K |
| D1110 |
Prophylaxis - adult |
2,992 |
2,982 |
$133K |
| D0272 |
Bitewings - two radiographic images |
6,999 |
6,968 |
$128K |
| D0220 |
Intraoral - periapical first radiographic image |
8,723 |
8,686 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,538 |
8,491 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,364 |
3,357 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,306 |
2,298 |
$68K |
| D1351 |
Sealant - per tooth |
1,378 |
411 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
835 |
833 |
$21K |
| D1354 |
|
2,017 |
941 |
$17K |
| D0330 |
Panoramic radiographic image |
214 |
214 |
$10K |