| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
568 |
474 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
734 |
621 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
206 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
209 |
$9K |
| D1206 |
Topical application of fluoride varnish |
410 |
325 |
$8K |
| D0274 |
Bitewings - four radiographic images |
157 |
140 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
12 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
54 |
$4K |
| D1120 |
Prophylaxis - child |
68 |
52 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
46 |
42 |
$604.31 |