| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
841 |
825 |
$24K |
| D1120 |
Prophylaxis - child |
438 |
430 |
$16K |
| D1110 |
Prophylaxis - adult |
260 |
257 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
864 |
850 |
$12K |
| D1351 |
Sealant - per tooth |
443 |
89 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
730 |
717 |
$8K |
| D0272 |
Bitewings - two radiographic images |
345 |
339 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
813 |
674 |
$7K |
| D0330 |
Panoramic radiographic image |
118 |
116 |
$7K |
| D0274 |
Bitewings - four radiographic images |
188 |
185 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
42 |
$6K |
| D0602 |
|
195 |
193 |
$0.00 |
| D0603 |
|
685 |
674 |
$0.00 |