| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,364 |
1,337 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,342 |
1,316 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,062 |
2,015 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
162 |
158 |
$21K |
| D0272 |
Bitewings - two radiographic images |
922 |
904 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,559 |
1,508 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,572 |
1,433 |
$15K |
| D1110 |
Prophylaxis - adult |
97 |
97 |
$5K |
| D1351 |
Sealant - per tooth |
194 |
29 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
121 |
$4K |
| D0274 |
Bitewings - four radiographic images |
122 |
121 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
16 |
$300.48 |
| D0603 |
|
1,821 |
1,777 |
$0.00 |
| D0602 |
|
21 |
21 |
$0.00 |
| D0601 |
|
83 |
82 |
$0.00 |