| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
418 |
375 |
$16K |
| D0274 |
Bitewings - four radiographic images |
626 |
578 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,146 |
1,044 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
363 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
579 |
532 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
949 |
814 |
$6K |
| D1206 |
Topical application of fluoride varnish |
153 |
145 |
$5K |
| D0270 |
|
252 |
237 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
30 |
30 |
$900.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
96 |
78 |
$817.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$797.76 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$260.00 |