| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,588 |
1,370 |
$56K |
| D1110 |
Prophylaxis - adult |
807 |
739 |
$51K |
| D1120 |
Prophylaxis - child |
595 |
549 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
775 |
686 |
$21K |
| D1206 |
Topical application of fluoride varnish |
653 |
612 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
906 |
819 |
$20K |
| D1351 |
Sealant - per tooth |
439 |
120 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
761 |
655 |
$13K |
| D0274 |
Bitewings - four radiographic images |
151 |
143 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
86 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
38 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
16 |
14 |
$516.49 |
| D1999 |
|
600 |
527 |
$0.00 |
| D0603 |
|
532 |
477 |
$0.00 |
| D0602 |
|
835 |
788 |
$0.00 |