| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
26,804 |
4,383 |
$426K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,286 |
7,651 |
$236K |
| D1120 |
Prophylaxis - child |
10,729 |
8,802 |
$182K |
| D1206 |
Topical application of fluoride varnish |
8,857 |
7,265 |
$127K |
| D0140 |
Limited oral evaluation - problem focused |
3,039 |
2,621 |
$80K |
| D0272 |
Bitewings - two radiographic images |
4,953 |
4,161 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,280 |
1,146 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,618 |
2,284 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,207 |
948 |
$17K |
| D0350 |
|
621 |
480 |
$11K |