| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,392 |
2,077 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,455 |
1,295 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,317 |
1,140 |
$25K |
| D1999 |
|
1,752 |
1,630 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,383 |
1,223 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,422 |
1,197 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
850 |
712 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,462 |
1,281 |
$10K |
| D1120 |
Prophylaxis - child |
353 |
287 |
$6K |
| D1351 |
Sealant - per tooth |
93 |
19 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
48 |
$591.00 |