| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
979 |
888 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,097 |
1,004 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
200 |
181 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
42 |
$3K |
| D0272 |
Bitewings - two radiographic images |
229 |
194 |
$2K |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
29 |
$631.50 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$162.00 |