| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
968 |
731 |
$29K |
| D1120 |
Prophylaxis - child |
347 |
244 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
120 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
154 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
255 |
219 |
$2K |
| D0330 |
Panoramic radiographic image |
63 |
56 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
36 |
26 |
$575.48 |
| D0272 |
Bitewings - two radiographic images |
16 |
14 |
$197.47 |