| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
419 |
395 |
$38K |
| D0999 |
Unspecified diagnostic procedure, by report |
337 |
242 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
96 |
71 |
$3K |
| D1206 |
Topical application of fluoride varnish |
134 |
109 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
58 |
$966.26 |
| D0140 |
Limited oral evaluation - problem focused |
65 |
47 |
$425.82 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$251.38 |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
14 |
$0.00 |