| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,140 |
3,020 |
$63K |
| D1120 |
Prophylaxis - child |
1,980 |
1,911 |
$59K |
| D1110 |
Prophylaxis - adult |
1,256 |
1,205 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,437 |
2,348 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
673 |
658 |
$11K |
| D0272 |
Bitewings - two radiographic images |
555 |
537 |
$11K |
| D0274 |
Bitewings - four radiographic images |
276 |
271 |
$7K |
| D1351 |
Sealant - per tooth |
70 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
66 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
28 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
25 |
$295.83 |