| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
705 |
553 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
975 |
766 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
587 |
434 |
$19K |
| D0272 |
Bitewings - two radiographic images |
801 |
624 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
502 |
372 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
377 |
276 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
12 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
47 |
$831.81 |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$281.30 |