| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,040 |
920 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
626 |
542 |
$16K |
| D1206 |
Topical application of fluoride varnish |
654 |
597 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
284 |
$11K |
| D0274 |
Bitewings - four radiographic images |
352 |
291 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
117 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
145 |
$2K |
| D0330 |
Panoramic radiographic image |
82 |
47 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
79 |
$1K |