| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,441 |
1,410 |
$40K |
| D1120 |
Prophylaxis - child |
926 |
905 |
$32K |
| D1110 |
Prophylaxis - adult |
550 |
539 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,587 |
1,552 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,806 |
1,472 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,602 |
1,555 |
$19K |
| D0274 |
Bitewings - four radiographic images |
523 |
513 |
$17K |
| D0272 |
Bitewings - two radiographic images |
598 |
584 |
$14K |
| D1351 |
Sealant - per tooth |
365 |
63 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
65 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0602 |
|
2,071 |
2,016 |
$0.00 |