| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
562 |
522 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
718 |
670 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
156 |
153 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
154 |
152 |
$1K |
| D1110 |
Prophylaxis - adult |
81 |
79 |
$1K |
| D1120 |
Prophylaxis - child |
14 |
14 |
$248.14 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$212.59 |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
12 |
$92.73 |