| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
901 |
819 |
$25K |
| D1206 |
Topical application of fluoride varnish |
646 |
584 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
479 |
455 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
257 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
75 |
$3K |
| D0330 |
Panoramic radiographic image |
41 |
38 |
$1K |
| D0274 |
Bitewings - four radiographic images |
41 |
40 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$877.44 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
24 |
$436.34 |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
31 |
$304.38 |
| D0603 |
|
88 |
88 |
$0.00 |
| D1999 |
|
427 |
398 |
$0.00 |