| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
640 |
595 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,124 |
1,030 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
902 |
845 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
341 |
$16K |
| D1110 |
Prophylaxis - adult |
505 |
459 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
421 |
378 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
189 |
171 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
41 |
$6K |
| D0274 |
Bitewings - four radiographic images |
87 |
82 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
179 |
154 |
$2K |
| D1999 |
|
239 |
189 |
$0.00 |