| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
960 |
951 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
750 |
732 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,015 |
1,009 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
165 |
96 |
$17K |
| D1110 |
Prophylaxis - adult |
331 |
330 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
563 |
558 |
$13K |
| D0330 |
Panoramic radiographic image |
238 |
234 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
805 |
788 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
183 |
$6K |
| D0274 |
Bitewings - four radiographic images |
263 |
258 |
$6K |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$778.24 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$537.57 |