| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
532 |
526 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
510 |
504 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
718 |
711 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
942 |
590 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
720 |
708 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
52 |
$7K |
| D1110 |
Prophylaxis - adult |
131 |
126 |
$7K |
| D0274 |
Bitewings - four radiographic images |
250 |
243 |
$6K |
| D0272 |
Bitewings - two radiographic images |
188 |
187 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
92 |
$3K |
| D1206 |
Topical application of fluoride varnish |
168 |
161 |
$2K |
| D1351 |
Sealant - per tooth |
93 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$918.32 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$108.09 |
| D0602 |
|
325 |
318 |
$0.00 |
| D0603 |
|
468 |
466 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |