| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,635 |
1,527 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
1,856 |
1,775 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
812 |
581 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
415 |
376 |
$26K |
| D0999 |
Unspecified diagnostic procedure, by report |
449 |
239 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,364 |
1,246 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
107 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
235 |
$8K |
| D1351 |
Sealant - per tooth |
130 |
70 |
$7K |
| D0274 |
Bitewings - four radiographic images |
137 |
129 |
$5K |
| D0330 |
Panoramic radiographic image |
198 |
198 |
$4K |
| D1110 |
Prophylaxis - adult |
51 |
51 |
$4K |
| D0272 |
Bitewings - two radiographic images |
133 |
125 |
$2K |
| D0601 |
|
336 |
318 |
$1K |
| D0602 |
|
105 |
103 |
$656.38 |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
250 |
$600.29 |
| D0603 |
|
12 |
12 |
$187.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
20 |
$121.60 |