| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
719 |
710 |
$20K |
| D1120 |
Prophylaxis - child |
469 |
457 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
810 |
796 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
737 |
715 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
69 |
63 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
728 |
678 |
$8K |
| D0274 |
Bitewings - four radiographic images |
186 |
180 |
$6K |
| D1110 |
Prophylaxis - adult |
92 |
92 |
$5K |
| D0272 |
Bitewings - two radiographic images |
194 |
189 |
$4K |
| D1351 |
Sealant - per tooth |
171 |
43 |
$4K |
| D0602 |
|
133 |
132 |
$0.00 |
| D0601 |
|
500 |
480 |
$0.00 |
| D0603 |
|
106 |
105 |
$0.00 |