| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,365 |
1,352 |
$63K |
| D1120 |
Prophylaxis - child |
993 |
983 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,391 |
1,139 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,232 |
1,224 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
113 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
487 |
478 |
$6K |
| D0272 |
Bitewings - two radiographic images |
468 |
461 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
76 |
$4K |
| D1351 |
Sealant - per tooth |
179 |
53 |
$4K |
| D1110 |
Prophylaxis - adult |
27 |
26 |
$2K |
| D0350 |
|
123 |
66 |
$1K |