| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
63 |
62 |
$9K |
| D1206 |
Topical application of fluoride varnish |
129 |
122 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
177 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
91 |
81 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
40 |
31 |
$1K |
| D1120 |
Prophylaxis - child |
20 |
18 |
$810.00 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
15 |
$498.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
49 |
$407.71 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$235.20 |
| D0603 |
|
175 |
167 |
$175.00 |