| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,193 |
3,284 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,259 |
1,997 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,900 |
2,186 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,671 |
1,064 |
$37K |
| D1351 |
Sealant - per tooth |
1,483 |
308 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
830 |
722 |
$29K |
| D0330 |
Panoramic radiographic image |
728 |
504 |
$21K |
| D0272 |
Bitewings - two radiographic images |
732 |
565 |
$11K |
| D0274 |
Bitewings - four radiographic images |
257 |
240 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
436 |
381 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
242 |
189 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
13 |
$397.68 |
| D1110 |
Prophylaxis - adult |
16 |
13 |
$182.20 |
| D1999 |
|
111 |
95 |
$0.00 |