| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,101 |
1,070 |
$29K |
| D1120 |
Prophylaxis - child |
818 |
791 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,140 |
1,103 |
$15K |
| D1110 |
Prophylaxis - adult |
257 |
246 |
$12K |
| D1351 |
Sealant - per tooth |
496 |
75 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,136 |
1,090 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
809 |
782 |
$7K |
| D0272 |
Bitewings - two radiographic images |
400 |
392 |
$7K |
| D0274 |
Bitewings - four radiographic images |
281 |
268 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
81 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
101 |
95 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$988.96 |
| D0603 |
|
337 |
323 |
$0.01 |
| D0601 |
|
1,000 |
950 |
$0.00 |
| D0602 |
|
32 |
31 |
$0.00 |