| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,820 |
3,629 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
3,609 |
3,437 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,723 |
3,537 |
$96K |
| D1351 |
Sealant - per tooth |
259 |
159 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,618 |
3,414 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,988 |
1,913 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
592 |
555 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,082 |
2,939 |
$13K |
| D0330 |
Panoramic radiographic image |
465 |
434 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
66 |
$1K |