| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
855 |
817 |
$36K |
| D1206 |
Topical application of fluoride varnish |
850 |
815 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,023 |
982 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
690 |
643 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
308 |
281 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
743 |
726 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,254 |
1,201 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,201 |
1,080 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
338 |
$7K |
| D1351 |
Sealant - per tooth |
103 |
15 |
$2K |
| D1110 |
Prophylaxis - adult |
69 |
68 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
13 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
17 |
17 |
$510.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
16 |
16 |
$320.00 |