| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,170 |
1,111 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,386 |
1,301 |
$33K |
| D1110 |
Prophylaxis - adult |
656 |
613 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,265 |
2,081 |
$18K |
| D0274 |
Bitewings - four radiographic images |
665 |
614 |
$16K |
| D1120 |
Prophylaxis - child |
255 |
240 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
565 |
528 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
185 |
130 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,028 |
867 |
$6K |