| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
687 |
665 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
961 |
927 |
$24K |
| D0272 |
Bitewings - two radiographic images |
634 |
616 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
532 |
528 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
294 |
279 |
$9K |
| D1206 |
Topical application of fluoride varnish |
250 |
235 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
174 |
161 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$429.30 |