| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,694 |
1,623 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,802 |
1,724 |
$50K |
| D1206 |
Topical application of fluoride varnish |
904 |
879 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
91 |
$11K |
| D0274 |
Bitewings - four radiographic images |
342 |
332 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
206 |
$4K |
| D1110 |
Prophylaxis - adult |
58 |
58 |
$2K |
| D0272 |
Bitewings - two radiographic images |
86 |
83 |
$870.17 |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
111 |
$694.59 |
| D0330 |
Panoramic radiographic image |
26 |
25 |
$613.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
51 |
$288.80 |