| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,555 |
6,401 |
$296K |
| D1206 |
Topical application of fluoride varnish |
9,881 |
9,628 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
9,196 |
8,976 |
$231K |
| D1120 |
Prophylaxis - child |
5,076 |
4,942 |
$221K |
| D1351 |
Sealant - per tooth |
4,682 |
1,285 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,256 |
2,186 |
$103K |
| D0330 |
Panoramic radiographic image |
2,237 |
2,166 |
$95K |
| D0274 |
Bitewings - four radiographic images |
4,281 |
4,186 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
1,396 |
1,341 |
$45K |
| D1330 |
|
4,033 |
3,921 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,227 |
1,187 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,353 |
2,294 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
224 |
197 |
$2K |