| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
532 |
493 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
453 |
419 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
418 |
383 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
26 |
$6K |
| D0272 |
Bitewings - two radiographic images |
227 |
211 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
132 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
43 |
$2K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$170.03 |