| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,018 |
4,007 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
5,084 |
5,069 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
2,008 |
2,002 |
$22K |
| D0274 |
Bitewings - four radiographic images |
784 |
781 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,676 |
1,669 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
342 |
341 |
$12K |
| D1120 |
Prophylaxis - child |
118 |
118 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
54 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
71 |
71 |
$761.60 |
| D0140 |
Limited oral evaluation - problem focused |
60 |
60 |
$745.58 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$200.80 |