| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,201 |
1,143 |
$47K |
| D1206 |
Topical application of fluoride varnish |
846 |
797 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
765 |
739 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
373 |
348 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
427 |
406 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
487 |
$8K |
| D0272 |
Bitewings - two radiographic images |
260 |
254 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
245 |
245 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
112 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
13 |
$833.69 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$624.13 |