| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,957 |
1,935 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,724 |
1,706 |
$43K |
| D1351 |
Sealant - per tooth |
1,840 |
524 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,169 |
2,146 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
381 |
194 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
647 |
643 |
$12K |
| D1110 |
Prophylaxis - adult |
242 |
239 |
$10K |
| D0272 |
Bitewings - two radiographic images |
517 |
514 |
$9K |
| D0274 |
Bitewings - four radiographic images |
283 |
282 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
766 |
732 |
$7K |
| D7310 |
|
80 |
69 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
759 |
589 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
110 |
107 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
26 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
41 |
$597.00 |