| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,131 |
2,126 |
$115K |
| D1120 |
Prophylaxis - child |
1,961 |
1,957 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,313 |
2,074 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,241 |
2,235 |
$31K |
| D1110 |
Prophylaxis - adult |
304 |
304 |
$27K |
| D1351 |
Sealant - per tooth |
802 |
240 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
117 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,198 |
1,197 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
192 |
$13K |
| D0274 |
Bitewings - four radiographic images |
577 |
577 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
200 |
200 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
452 |
452 |
$4K |
| D1320 |
|
240 |
240 |
$3K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$312.00 |