| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
1,120 |
866 |
$16K |
| D1120 |
Prophylaxis - child |
725 |
544 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
502 |
367 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
773 |
584 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
267 |
228 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
120 |
96 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
27 |
$872.20 |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
31 |
$438.60 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$273.00 |