| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,023 |
977 |
$41K |
| D1120 |
Prophylaxis - child |
1,208 |
1,155 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,009 |
963 |
$23K |
| D0274 |
Bitewings - four radiographic images |
338 |
318 |
$10K |
| D1351 |
Sealant - per tooth |
256 |
39 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
219 |
199 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
63 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
36 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
39 |
$758.37 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$177.96 |
| D1999 |
|
102 |
93 |
$0.00 |