| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
587 |
580 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
702 |
675 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
109 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
513 |
507 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
300 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
846 |
796 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
435 |
430 |
$7K |
| D1120 |
Prophylaxis - child |
207 |
205 |
$6K |
| D9110 |
|
189 |
175 |
$6K |
| D9920 |
|
60 |
52 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
105 |
$5K |
| D1330 |
|
374 |
372 |
$1K |
| D1999 |
|
14 |
13 |
$0.00 |