| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,394 |
1,370 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,494 |
1,469 |
$2K |
| D1120 |
Prophylaxis - child |
728 |
720 |
$2K |
| D1110 |
Prophylaxis - adult |
557 |
548 |
$2K |
| D0274 |
Bitewings - four radiographic images |
326 |
317 |
$797.49 |
| D0272 |
Bitewings - two radiographic images |
323 |
319 |
$531.30 |
| D0220 |
Intraoral - periapical first radiographic image |
335 |
326 |
$527.45 |
| D0230 |
Intraoral - periapical each additional radiographic image |
205 |
202 |
$347.00 |
| D1351 |
Sealant - per tooth |
41 |
12 |
$93.52 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
53 |
$69.16 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$58.17 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$29.46 |