| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
837 |
758 |
$106K |
| D1120 |
Prophylaxis - child |
1,887 |
1,786 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,838 |
1,742 |
$49K |
| D1206 |
Topical application of fluoride varnish |
1,932 |
1,836 |
$26K |
| D1351 |
Sealant - per tooth |
921 |
196 |
$24K |
| D0272 |
Bitewings - two radiographic images |
937 |
891 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
461 |
$5K |
| D0330 |
Panoramic radiographic image |
119 |
110 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
129 |
$4K |
| D1110 |
Prophylaxis - adult |
67 |
65 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
170 |
156 |
$2K |
| D9248 |
|
14 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
39 |
37 |
$876.34 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
29 |
$540.86 |
| D0603 |
|
2,931 |
2,743 |
$0.00 |