| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,322 |
1,315 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
886 |
882 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
501 |
499 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,482 |
1,408 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
205 |
205 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
75 |
51 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
664 |
599 |
$8K |
| D9430 |
|
230 |
226 |
$7K |
| D0272 |
Bitewings - two radiographic images |
472 |
470 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
182 |
$3K |
| D1999 |
|
311 |
252 |
$280.00 |