| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,046 |
1,044 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
937 |
935 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,128 |
1,125 |
$16K |
| D0272 |
Bitewings - two radiographic images |
520 |
518 |
$12K |
| D1351 |
Sealant - per tooth |
393 |
67 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
757 |
744 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
68 |
65 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
757 |
571 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
141 |
$5K |
| D0603 |
|
1,588 |
1,578 |
$0.00 |