| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
534 |
515 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
602 |
589 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
461 |
443 |
$11K |
| D1206 |
Topical application of fluoride varnish |
280 |
279 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
112 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
84 |
78 |
$4K |
| D0272 |
Bitewings - two radiographic images |
151 |
145 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
24 |
$4K |
| D0274 |
Bitewings - four radiographic images |
76 |
76 |
$3K |
| D1110 |
Prophylaxis - adult |
51 |
51 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
43 |
$899.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$886.00 |