| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,276 |
3,239 |
$277K |
| D1120 |
Prophylaxis - child |
3,111 |
3,083 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
4,516 |
4,472 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,890 |
1,871 |
$48K |
| D1351 |
Sealant - per tooth |
8,448 |
2,425 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,433 |
6,371 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,553 |
3,247 |
$4K |
| D0272 |
Bitewings - two radiographic images |
4,505 |
4,462 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,467 |
3,431 |
$2K |
| D1330 |
|
6,434 |
6,372 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
96 |
96 |
$2K |
| D1999 |
|
15 |
15 |
$600.00 |
| D0274 |
Bitewings - four radiographic images |
716 |
709 |
$547.78 |