| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,307 |
1,232 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,289 |
1,213 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,499 |
1,438 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
795 |
727 |
$16K |
| D0274 |
Bitewings - four radiographic images |
462 |
425 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,239 |
1,140 |
$7K |
| D4341 |
|
22 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
562 |
506 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
230 |
212 |
$4K |
| D1110 |
Prophylaxis - adult |
133 |
105 |
$3K |
| D1351 |
Sealant - per tooth |
18 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
27 |
$613.30 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$293.80 |
| D1999 |
|
78 |
62 |
$0.00 |