| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,289 |
6,122 |
$255K |
| D4260 |
|
437 |
239 |
$178K |
| D1206 |
Topical application of fluoride varnish |
6,187 |
6,024 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
5,584 |
5,426 |
$155K |
| D1351 |
Sealant - per tooth |
1,060 |
640 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,534 |
2,474 |
$56K |
| D4341 |
|
132 |
51 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
107 |
$6K |
| D0274 |
Bitewings - four radiographic images |
277 |
277 |
$5K |
| D2394 |
|
18 |
13 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
451 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
444 |
444 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
52 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
88 |
$1K |
| D0272 |
Bitewings - two radiographic images |
92 |
92 |
$1K |