| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
457 |
442 |
$15K |
| D1206 |
Topical application of fluoride varnish |
177 |
172 |
$9K |
| D0274 |
Bitewings - four radiographic images |
308 |
296 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
381 |
368 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
67 |
$6K |
| D1120 |
Prophylaxis - child |
89 |
84 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
96 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
38 |
36 |
$1K |
| D9994 |
|
113 |
110 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
169 |
156 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$597.72 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$577.36 |