| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,174 |
1,758 |
$64K |
| D1120 |
Prophylaxis - child |
1,966 |
1,475 |
$40K |
| D0330 |
Panoramic radiographic image |
1,093 |
813 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,686 |
1,292 |
$29K |
| D1351 |
Sealant - per tooth |
2,041 |
191 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,064 |
731 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
341 |
125 |
$15K |
| D0274 |
Bitewings - four radiographic images |
369 |
283 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
319 |
230 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
251 |
163 |
$2K |