| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,462 |
1,900 |
$81K |
| D1206 |
Topical application of fluoride varnish |
2,908 |
2,282 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,953 |
1,580 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
434 |
335 |
$10K |
| D1110 |
Prophylaxis - adult |
117 |
110 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
344 |
280 |
$3K |
| D0272 |
Bitewings - two radiographic images |
250 |
170 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
341 |
125 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
13 |
$811.62 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
26 |
$432.12 |
| D1330 |
|
420 |
316 |
$0.00 |
| D0601 |
|
113 |
82 |
$0.00 |
| D0603 |
|
74 |
57 |
$0.00 |
| D0602 |
|
95 |
69 |
$0.00 |
| D1999 |
|
12 |
12 |
$0.00 |