| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,188 |
984 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
123 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
606 |
496 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
844 |
664 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,510 |
1,148 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
929 |
765 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
298 |
251 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
609 |
432 |
$6K |
| D0272 |
Bitewings - two radiographic images |
98 |
89 |
$2K |
| D0274 |
Bitewings - four radiographic images |
66 |
55 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
28 |
$1K |
| D1206 |
Topical application of fluoride varnish |
44 |
27 |
$433.40 |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$156.00 |