| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,803 |
2,736 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,100 |
3,016 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,724 |
2,653 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,357 |
1,326 |
$23K |
| D1110 |
Prophylaxis - adult |
298 |
281 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
235 |
218 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
39 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
37 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
45 |
$2K |
| D1351 |
Sealant - per tooth |
43 |
12 |
$751.70 |
| D0140 |
Limited oral evaluation - problem focused |
52 |
49 |
$660.00 |