| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
535 |
502 |
$14K |
| D1110 |
Prophylaxis - adult |
265 |
260 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,038 |
982 |
$12K |
| D1351 |
Sealant - per tooth |
423 |
61 |
$11K |
| D1120 |
Prophylaxis - child |
306 |
299 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
969 |
890 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
217 |
$7K |
| D0274 |
Bitewings - four radiographic images |
180 |
175 |
$6K |
| D0272 |
Bitewings - two radiographic images |
255 |
252 |
$6K |
| D1206 |
Topical application of fluoride varnish |
440 |
411 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
396 |
387 |
$6K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$524.01 |
| D0602 |
|
1,327 |
1,299 |
$0.01 |