| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,377 |
1,083 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
604 |
427 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,156 |
952 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,132 |
890 |
$13K |
| D0274 |
Bitewings - four radiographic images |
677 |
506 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
403 |
190 |
$10K |
| D2140 |
|
162 |
86 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
165 |
90 |
$4K |
| D0330 |
Panoramic radiographic image |
57 |
31 |
$3K |
| D1110 |
Prophylaxis - adult |
51 |
39 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
438 |
321 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
17 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
129 |
113 |
$1K |
| D0272 |
Bitewings - two radiographic images |
17 |
12 |
$814.96 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
43 |
$0.00 |