| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,082 |
1,073 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
855 |
841 |
$15K |
| D0274 |
Bitewings - four radiographic images |
725 |
714 |
$12K |
| D1120 |
Prophylaxis - child |
486 |
478 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
520 |
501 |
$9K |
| D1206 |
Topical application of fluoride varnish |
624 |
614 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
364 |
355 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
67 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
521 |
503 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
164 |
160 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |
| T1015 |
Clinic visit/encounter, all-inclusive |
12 |
12 |
$0.00 |