| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
627 |
576 |
$74K |
| D1120 |
Prophylaxis - child |
410 |
384 |
$13K |
| D0272 |
Bitewings - two radiographic images |
244 |
230 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
180 |
170 |
$5K |
| D1351 |
Sealant - per tooth |
174 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
350 |
328 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
370 |
297 |
$3K |
| D1206 |
Topical application of fluoride varnish |
189 |
178 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
143 |
137 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
41 |
$1K |
| D0350 |
|
67 |
65 |
$1K |
| D0603 |
|
1,191 |
1,104 |
$0.00 |