| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,641 |
2,638 |
$225K |
| D0120 |
Periodic oral evaluation - established patient |
3,444 |
3,440 |
$186K |
| D0210 |
Intraoral - complete series of radiographic images |
1,355 |
1,354 |
$61K |
| D4910 |
|
507 |
507 |
$39K |
| D1120 |
Prophylaxis - child |
887 |
886 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,294 |
2,292 |
$26K |
| D4341 |
|
359 |
97 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
396 |
396 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
737 |
721 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
571 |
557 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
39 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
68 |
$578.00 |
| D9430 |
|
12 |
12 |
$384.00 |