| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,051 |
944 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
658 |
588 |
$24K |
| D1206 |
Topical application of fluoride varnish |
701 |
680 |
$14K |
| D8670 |
Periodic orthodontic treatment visit |
99 |
93 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
371 |
344 |
$8K |
| D1351 |
Sealant - per tooth |
282 |
46 |
$8K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$6K |
| D0274 |
Bitewings - four radiographic images |
150 |
148 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
236 |
224 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
143 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
29 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109 |
79 |
$1K |
| D0272 |
Bitewings - two radiographic images |
46 |
46 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$1K |
| D1999 |
|
811 |
649 |
$0.00 |