| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
393 |
355 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
458 |
409 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
363 |
329 |
$9K |
| D0274 |
Bitewings - four radiographic images |
371 |
331 |
$6K |
| D1110 |
Prophylaxis - adult |
146 |
131 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
141 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
430 |
397 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
367 |
298 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$782.40 |
| D0140 |
Limited oral evaluation - problem focused |
34 |
28 |
$534.60 |
| D1999 |
|
56 |
40 |
$0.00 |