| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,621 |
1,604 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,639 |
1,618 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,519 |
1,502 |
$39K |
| D1351 |
Sealant - per tooth |
542 |
226 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,668 |
1,523 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,596 |
1,565 |
$9K |
| D0274 |
Bitewings - four radiographic images |
491 |
481 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
245 |
239 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
269 |
263 |
$6K |
| D1110 |
Prophylaxis - adult |
183 |
180 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
137 |
134 |
$2K |
| D0272 |
Bitewings - two radiographic images |
221 |
219 |
$2K |