| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
358 |
344 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
347 |
333 |
$9K |
| D0272 |
Bitewings - two radiographic images |
310 |
295 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
449 |
427 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
477 |
408 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
349 |
329 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
24 |
$3K |
| D1351 |
Sealant - per tooth |
79 |
27 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
25 |
$883.00 |
| D1999 |
|
126 |
109 |
$0.00 |
| D0603 |
|
639 |
610 |
$0.00 |
| D1330 |
|
163 |
152 |
$0.00 |