| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
597 |
590 |
$14K |
| D1120 |
Prophylaxis - child |
549 |
547 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
296 |
292 |
$11K |
| D1206 |
Topical application of fluoride varnish |
663 |
661 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
93 |
$8K |
| D1110 |
Prophylaxis - adult |
168 |
167 |
$5K |
| D0272 |
Bitewings - two radiographic images |
338 |
335 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
203 |
186 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
40 |
$972.20 |