| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
522 |
512 |
$70K |
| D1120 |
Prophylaxis - child |
924 |
892 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,108 |
1,074 |
$30K |
| D1110 |
Prophylaxis - adult |
480 |
460 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,335 |
1,284 |
$18K |
| D0274 |
Bitewings - four radiographic images |
410 |
395 |
$11K |
| D0272 |
Bitewings - two radiographic images |
562 |
540 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
294 |
$10K |
| D0330 |
Panoramic radiographic image |
381 |
358 |
$9K |
| D1351 |
Sealant - per tooth |
128 |
15 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
274 |
219 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
95 |
91 |
$677.24 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0602 |
|
2,045 |
2,008 |
$0.00 |