| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,248 |
2,223 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,195 |
2,171 |
$44K |
| D0330 |
Panoramic radiographic image |
898 |
882 |
$32K |
| D1351 |
Sealant - per tooth |
1,299 |
211 |
$32K |
| D0274 |
Bitewings - four radiographic images |
822 |
806 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,087 |
1,071 |
$23K |
| D1206 |
Topical application of fluoride varnish |
890 |
884 |
$16K |
| D1120 |
Prophylaxis - child |
515 |
511 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,395 |
1,371 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
890 |
836 |
$11K |
| D1330 |
|
379 |
372 |
$2K |
| D2140 |
|
38 |
27 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |