| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
937 |
937 |
$133K |
| D1120 |
Prophylaxis - child |
2,283 |
2,277 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,681 |
2,671 |
$77K |
| D1110 |
Prophylaxis - adult |
1,296 |
1,289 |
$70K |
| D1351 |
Sealant - per tooth |
2,292 |
686 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,638 |
1,631 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,640 |
3,627 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,761 |
1,756 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,789 |
2,780 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
977 |
973 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,771 |
2,741 |
$32K |
| D0330 |
Panoramic radiographic image |
720 |
715 |
$30K |
| D0603 |
|
895 |
890 |
$0.00 |
| D0601 |
|
1,513 |
1,508 |
$0.00 |
| D0602 |
|
2,188 |
2,179 |
$0.00 |