| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
467 |
418 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
577 |
513 |
$14K |
| D1206 |
Topical application of fluoride varnish |
465 |
416 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
484 |
403 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
221 |
198 |
$11K |
| D0274 |
Bitewings - four radiographic images |
538 |
479 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,043 |
884 |
$10K |
| D1351 |
Sealant - per tooth |
551 |
69 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
886 |
697 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
240 |
218 |
$4K |
| D1110 |
Prophylaxis - adult |
90 |
82 |
$2K |