| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,955 |
1,912 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,227 |
1,186 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
678 |
669 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,566 |
1,526 |
$41K |
| D0330 |
Panoramic radiographic image |
411 |
400 |
$24K |
| D1120 |
Prophylaxis - child |
591 |
588 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,543 |
1,516 |
$21K |
| D1351 |
Sealant - per tooth |
275 |
26 |
$6K |
| D0274 |
Bitewings - four radiographic images |
182 |
178 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$345.56 |
| D0603 |
|
1,275 |
1,254 |
$76.02 |
| D0601 |
|
828 |
812 |
$0.00 |
| D0602 |
|
120 |
119 |
$0.00 |
| D1999 |
|
127 |
115 |
$0.00 |