| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,859 |
2,823 |
$180K |
| D1120 |
Prophylaxis - child |
3,626 |
3,568 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,411 |
4,333 |
$124K |
| D1110 |
Prophylaxis - adult |
2,465 |
2,421 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,893 |
3,820 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
823 |
811 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,280 |
1,260 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,650 |
1,589 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,538 |
1,475 |
$19K |
| D1351 |
Sealant - per tooth |
177 |
56 |
$5K |
| D0272 |
Bitewings - two radiographic images |
41 |
38 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$787.80 |