| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,418 |
3,402 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
4,144 |
4,130 |
$117K |
| D1110 |
Prophylaxis - adult |
1,440 |
1,433 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,811 |
2,804 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,105 |
2,091 |
$45K |
| D1206 |
Topical application of fluoride varnish |
836 |
835 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,066 |
1,046 |
$14K |
| D1351 |
Sealant - per tooth |
346 |
94 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
190 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
131 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
188 |
128 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
99 |
$2K |
| D2140 |
|
16 |
13 |
$1K |