| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,662 |
1,643 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,635 |
1,615 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,135 |
1,118 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
319 |
$8K |
| D0272 |
Bitewings - two radiographic images |
681 |
670 |
$6K |
| D0330 |
Panoramic radiographic image |
117 |
115 |
$5K |
| D0240 |
|
338 |
254 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
261 |
257 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
56 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
85 |
75 |
$417.25 |
| D1999 |
|
22 |
21 |
$0.00 |
| D0603 |
|
28 |
27 |
$0.00 |