| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
752 |
725 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,561 |
1,380 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,256 |
1,218 |
$34K |
| D1351 |
Sealant - per tooth |
1,136 |
193 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,182 |
1,153 |
$26K |
| D1120 |
Prophylaxis - child |
661 |
646 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
157 |
153 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,473 |
1,425 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,120 |
1,106 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
203 |
$7K |
| D1206 |
Topical application of fluoride varnish |
179 |
163 |
$2K |
| D0274 |
Bitewings - four radiographic images |
43 |
42 |
$1K |
| D0603 |
|
1,042 |
1,006 |
$0.04 |
| D0602 |
|
881 |
856 |
$0.00 |