| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
379 |
333 |
$25K |
| D1120 |
Prophylaxis - child |
117 |
113 |
$9K |
| D0272 |
Bitewings - two radiographic images |
292 |
253 |
$8K |
| D0999 |
Unspecified diagnostic procedure, by report |
160 |
96 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
66 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
81 |
$6K |
| D0330 |
Panoramic radiographic image |
35 |
33 |
$651.32 |
| D1206 |
Topical application of fluoride varnish |
153 |
134 |
$325.66 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
14 |
$107.48 |
| D0601 |
|
13 |
13 |
$0.00 |