| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,798 |
5,761 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,069 |
7,017 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
2,343 |
2,325 |
$136K |
| D2160 |
|
1,615 |
429 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
5,402 |
5,360 |
$129K |
| D1110 |
Prophylaxis - adult |
2,215 |
2,196 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,262 |
2,255 |
$64K |
| D1351 |
Sealant - per tooth |
1,374 |
346 |
$39K |
| D2140 |
|
458 |
145 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,532 |
1,525 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,021 |
1,011 |
$28K |
| D9110 |
|
578 |
574 |
$27K |
| D0330 |
Panoramic radiographic image |
401 |
399 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
511 |
507 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
495 |
488 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
180 |
177 |
$4K |
| D1999 |
|
141 |
138 |
$0.00 |