| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,524 |
2,408 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,177 |
2,084 |
$58K |
| D1206 |
Topical application of fluoride varnish |
1,292 |
1,207 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
432 |
421 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
317 |
299 |
$7K |
| D0272 |
Bitewings - two radiographic images |
386 |
363 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
24 |
$3K |
| D1354 |
|
64 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
12 |
$228.42 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
12 |
$79.32 |