| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,056 |
1,522 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,369 |
1,004 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
573 |
174 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
698 |
536 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,504 |
1,096 |
$15K |
| D0272 |
Bitewings - two radiographic images |
693 |
507 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
632 |
424 |
$5K |
| D2140 |
|
151 |
59 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
37 |
$2K |