| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,215 |
4,084 |
$104K |
| D1120 |
Prophylaxis - child |
3,958 |
3,806 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,499 |
4,337 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
1,836 |
1,774 |
$14K |
| D0272 |
Bitewings - two radiographic images |
905 |
862 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
230 |
$8K |
| D1110 |
Prophylaxis - adult |
215 |
206 |
$8K |
| D1999 |
|
433 |
408 |
$6K |
| D0330 |
Panoramic radiographic image |
117 |
114 |
$5K |
| D0274 |
Bitewings - four radiographic images |
282 |
274 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,539 |
1,339 |
$3K |
| D1351 |
Sealant - per tooth |
34 |
12 |
$703.36 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$514.54 |