| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
325 |
305 |
$42K |
| D1120 |
Prophylaxis - child |
995 |
948 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,134 |
1,082 |
$31K |
| D1351 |
Sealant - per tooth |
722 |
152 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,290 |
1,224 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,234 |
1,162 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,267 |
1,108 |
$13K |
| D0274 |
Bitewings - four radiographic images |
317 |
294 |
$10K |
| D0272 |
Bitewings - two radiographic images |
444 |
424 |
$10K |
| D1110 |
Prophylaxis - adult |
151 |
141 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
28 |
$847.68 |
| D0603 |
|
127 |
123 |
$0.00 |
| D0601 |
|
1,012 |
965 |
$0.00 |
| D0602 |
|
319 |
305 |
$0.00 |