| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,279 |
223 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,139 |
1,113 |
$31K |
| D1110 |
Prophylaxis - adult |
561 |
544 |
$29K |
| D0274 |
Bitewings - four radiographic images |
637 |
620 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,389 |
1,356 |
$20K |
| D1120 |
Prophylaxis - child |
546 |
537 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,171 |
1,135 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,192 |
1,088 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
63 |
62 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
52 |
$2K |
| D0272 |
Bitewings - two radiographic images |
57 |
57 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$635.76 |
| D0603 |
|
987 |
942 |
$0.00 |
| D0602 |
|
481 |
473 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |