| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,477 |
1,418 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,201 |
2,094 |
$59K |
| D1351 |
Sealant - per tooth |
2,137 |
243 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,674 |
1,582 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,130 |
2,107 |
$42K |
| D1120 |
Prophylaxis - child |
995 |
936 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,378 |
2,259 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,355 |
2,224 |
$27K |
| D8670 |
Periodic orthodontic treatment visit |
394 |
371 |
$15K |
| D0272 |
Bitewings - two radiographic images |
213 |
193 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
77 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
85 |
81 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$246.99 |
| D0603 |
|
1,773 |
1,698 |
$0.00 |
| D0601 |
|
42 |
39 |
$0.00 |
| D0602 |
|
419 |
400 |
$0.00 |