| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,624 |
1,247 |
$455K |
| D1120 |
Prophylaxis - child |
1,992 |
1,637 |
$346K |
| D1206 |
Topical application of fluoride varnish |
4,265 |
3,265 |
$276K |
| D0140 |
Limited oral evaluation - problem focused |
637 |
494 |
$267K |
| D1351 |
Sealant - per tooth |
3,137 |
689 |
$117K |
| D1110 |
Prophylaxis - adult |
974 |
762 |
$101K |
| D0272 |
Bitewings - two radiographic images |
233 |
199 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
320 |
237 |
$40K |
| D0274 |
Bitewings - four radiographic images |
264 |
201 |
$27K |
| D0330 |
Panoramic radiographic image |
202 |
155 |
$11K |
| D2940 |
|
407 |
106 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
36 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
27 |
$5K |
| D1354 |
|
804 |
535 |
$0.00 |
| D0190 |
|
450 |
341 |
$0.00 |
| D0191 |
|
43 |
43 |
$0.00 |
| D1353 |
|
2,546 |
608 |
$0.00 |