| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
349 |
349 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,656 |
1,653 |
$48K |
| D1120 |
Prophylaxis - child |
1,124 |
1,121 |
$41K |
| D1351 |
Sealant - per tooth |
1,523 |
377 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,568 |
1,614 |
$29K |
| D1110 |
Prophylaxis - adult |
485 |
485 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,782 |
1,779 |
$26K |
| D0272 |
Bitewings - two radiographic images |
954 |
951 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,753 |
1,740 |
$22K |
| D0274 |
Bitewings - four radiographic images |
439 |
439 |
$15K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$225.36 |
| D0601 |
|
447 |
447 |
$0.00 |
| D0603 |
|
1,324 |
1,319 |
$0.00 |
| D0602 |
|
137 |
137 |
$0.00 |