| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
762 |
739 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,171 |
948 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
753 |
726 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,056 |
1,019 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,044 |
997 |
$12K |
| D1351 |
Sealant - per tooth |
328 |
62 |
$9K |
| D0274 |
Bitewings - four radiographic images |
290 |
269 |
$8K |
| D1110 |
Prophylaxis - adult |
166 |
155 |
$8K |
| D0272 |
Bitewings - two radiographic images |
328 |
321 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
212 |
209 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$5K |
| D0603 |
|
400 |
395 |
$9.02 |
| D0602 |
|
209 |
199 |
$0.00 |
| D0601 |
|
157 |
152 |
$0.00 |