| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,560 |
2,477 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,001 |
2,925 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,420 |
3,327 |
$68K |
| D1110 |
Prophylaxis - adult |
1,475 |
1,442 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,300 |
1,248 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,497 |
1,450 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
480 |
469 |
$22K |
| D0272 |
Bitewings - two radiographic images |
890 |
855 |
$12K |
| D1351 |
Sealant - per tooth |
333 |
74 |
$8K |
| D1206 |
Topical application of fluoride varnish |
125 |
118 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$585.60 |
| D1354 |
|
29 |
14 |
$267.57 |
| D9986 |
|
20 |
19 |
$0.00 |