| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,855 |
1,173 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
987 |
980 |
$27K |
| D1120 |
Prophylaxis - child |
672 |
665 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,224 |
1,215 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,295 |
1,262 |
$15K |
| D1110 |
Prophylaxis - adult |
264 |
264 |
$14K |
| D0274 |
Bitewings - four radiographic images |
605 |
603 |
$13K |
| D0272 |
Bitewings - two radiographic images |
297 |
294 |
$7K |
| D1351 |
Sealant - per tooth |
162 |
36 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
55 |
$2K |
| D0602 |
|
798 |
796 |
$0.00 |
| D0603 |
|
610 |
603 |
$0.00 |