| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,046 |
1,034 |
$145K |
| D1120 |
Prophylaxis - child |
1,756 |
1,731 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,864 |
1,848 |
$53K |
| D1351 |
Sealant - per tooth |
1,887 |
475 |
$51K |
| D1110 |
Prophylaxis - adult |
763 |
754 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,688 |
2,654 |
$39K |
| D0330 |
Panoramic radiographic image |
433 |
430 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,056 |
2,024 |
$25K |
| D0274 |
Bitewings - four radiographic images |
703 |
696 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,021 |
1,009 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,988 |
1,947 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
669 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
55 |
$1K |
| D0603 |
|
3,258 |
3,181 |
$0.00 |
| D0602 |
|
529 |
522 |
$0.00 |