| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,295 |
1,964 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,529 |
1,219 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,177 |
1,876 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
611 |
515 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
587 |
543 |
$16K |
| D0272 |
Bitewings - two radiographic images |
892 |
713 |
$13K |
| D1351 |
Sealant - per tooth |
388 |
53 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
502 |
408 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
52 |
$5K |
| D0330 |
Panoramic radiographic image |
63 |
63 |
$3K |
| D0274 |
Bitewings - four radiographic images |
90 |
78 |
$2K |
| D9310 |
|
64 |
54 |
$2K |
| D9986 |
|
35 |
29 |
$0.00 |