| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
34,872 |
34,847 |
$1.36M |
| D1351 |
Sealant - per tooth |
43,126 |
11,100 |
$1.21M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19,854 |
19,843 |
$844K |
| D1208 |
Topical application of fluoride, excluding varnish |
33,058 |
33,037 |
$778K |
| D0120 |
Periodic oral evaluation - established patient |
14,126 |
14,117 |
$383K |
| D0272 |
Bitewings - two radiographic images |
14,922 |
14,915 |
$332K |
| D1110 |
Prophylaxis - adult |
1,908 |
1,905 |
$87K |
| D1206 |
Topical application of fluoride varnish |
3,021 |
3,018 |
$86K |
| D0191 |
|
3,802 |
3,802 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
513 |
513 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
514 |
$8K |
| D0270 |
|
297 |
297 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
422 |
420 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$461.00 |