| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,020 |
993 |
$207.09 |
| D0220 |
Intraoral - periapical first radiographic image |
860 |
829 |
$76.09 |
| D1206 |
Topical application of fluoride varnish |
1,610 |
1,576 |
$33.48 |
| D1330 |
|
2,615 |
2,527 |
$27.47 |
| D0603 |
|
1,271 |
1,212 |
$22.32 |
| D1354 |
|
1,747 |
754 |
$22.32 |
| D0120 |
Periodic oral evaluation - established patient |
1,220 |
1,183 |
$0.00 |
| D0602 |
|
571 |
557 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
58 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
29 |
$0.00 |
| D0601 |
|
28 |
28 |
$0.00 |
| D1310 |
|
21 |
21 |
$0.00 |
| D1120 |
Prophylaxis - child |
195 |
195 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
493 |
482 |
$0.00 |
| D1110 |
Prophylaxis - adult |
900 |
876 |
$0.00 |
| D0191 |
|
35 |
35 |
$0.00 |