| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,890 |
2,772 |
$72K |
| D1120 |
Prophylaxis - child |
1,340 |
1,296 |
$63K |
| D1110 |
Prophylaxis - adult |
965 |
926 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,822 |
1,750 |
$29K |
| D0272 |
Bitewings - two radiographic images |
575 |
554 |
$9K |
| D0330 |
Panoramic radiographic image |
196 |
182 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
215 |
209 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
185 |
174 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
619 |
569 |
$5K |
| D1351 |
Sealant - per tooth |
84 |
25 |
$1K |
| D1206 |
Topical application of fluoride varnish |
70 |
70 |
$1K |
| D0274 |
Bitewings - four radiographic images |
37 |
36 |
$1K |
| D1999 |
|
329 |
301 |
$0.00 |