| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
950 |
845 |
$23K |
| D1120 |
Prophylaxis - child |
737 |
653 |
$22K |
| D0274 |
Bitewings - four radiographic images |
520 |
462 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,110 |
988 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,096 |
965 |
$11K |
| D1110 |
Prophylaxis - adult |
225 |
214 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,042 |
921 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$4K |
| D1351 |
Sealant - per tooth |
127 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
170 |
145 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
53 |
$2K |
| D1330 |
|
784 |
686 |
$196.00 |
| D0603 |
|
1,345 |
1,265 |
$0.00 |