| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,012 |
2,925 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
2,928 |
2,840 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,731 |
2,648 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
1,788 |
1,726 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,497 |
1,461 |
$7K |
| D0274 |
Bitewings - four radiographic images |
346 |
339 |
$6K |
| D1351 |
Sealant - per tooth |
102 |
66 |
$5K |
| D9110 |
|
32 |
31 |
$2K |
| D0272 |
Bitewings - two radiographic images |
68 |
67 |
$660.96 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$271.20 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$210.60 |
| D1999 |
|
37 |
34 |
$0.00 |