| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
546 |
466 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
142 |
$4K |
| D1120 |
Prophylaxis - child |
323 |
255 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
32 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
58 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
100 |
$1K |
| D1206 |
Topical application of fluoride varnish |
383 |
304 |
$356.60 |
| D0272 |
Bitewings - two radiographic images |
89 |
72 |
$219.28 |