| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,066 |
994 |
$198K |
| D1206 |
Topical application of fluoride varnish |
574 |
573 |
$20K |
| D1120 |
Prophylaxis - child |
452 |
446 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
697 |
689 |
$14K |
| D1110 |
Prophylaxis - adult |
190 |
189 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
372 |
223 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
146 |
112 |
$2K |
| D0274 |
Bitewings - four radiographic images |
58 |
58 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
201 |
188 |
$675.00 |
| D0220 |
Intraoral - periapical first radiographic image |
196 |
180 |
$672.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$360.00 |