| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,797 |
1,723 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,984 |
1,905 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,162 |
1,138 |
$30K |
| D1351 |
Sealant - per tooth |
335 |
220 |
$24K |
| D0274 |
Bitewings - four radiographic images |
475 |
473 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,212 |
1,168 |
$7K |
| D1110 |
Prophylaxis - adult |
139 |
137 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,075 |
1,036 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
176 |
$4K |
| D0272 |
Bitewings - two radiographic images |
337 |
316 |
$3K |
| D9110 |
|
23 |
23 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$1K |