| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,147 |
1,959 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
1,945 |
$27K |
| D0272 |
Bitewings - two radiographic images |
817 |
755 |
$11K |
| D1999 |
|
557 |
526 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,396 |
1,132 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,034 |
960 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
261 |
232 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
49 |
$3K |
| D2140 |
|
124 |
73 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
52 |
$903.37 |
| D1120 |
Prophylaxis - child |
27 |
27 |
$480.20 |