| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
817 |
801 |
$23K |
| D1120 |
Prophylaxis - child |
599 |
584 |
$21K |
| D0274 |
Bitewings - four radiographic images |
443 |
433 |
$14K |
| D1110 |
Prophylaxis - adult |
215 |
212 |
$11K |
| D1351 |
Sealant - per tooth |
413 |
65 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
730 |
712 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
566 |
551 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
727 |
708 |
$8K |
| D1206 |
Topical application of fluoride varnish |
325 |
319 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
30 |
$4K |
| D0272 |
Bitewings - two radiographic images |
166 |
160 |
$4K |
| D0603 |
|
1,218 |
1,187 |
$0.00 |