| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
460 |
444 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
560 |
536 |
$15K |
| D1206 |
Topical application of fluoride varnish |
543 |
519 |
$14K |
| D0274 |
Bitewings - four radiographic images |
53 |
52 |
$895.70 |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
14 |
$665.04 |
| D0272 |
Bitewings - two radiographic images |
59 |
59 |
$545.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$526.25 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$421.20 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$134.40 |
| D0601 |
|
18 |
18 |
$0.00 |