| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,679 |
1,632 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,654 |
2,554 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,826 |
1,741 |
$30K |
| D1120 |
Prophylaxis - child |
919 |
867 |
$27K |
| D0274 |
Bitewings - four radiographic images |
298 |
290 |
$6K |
| D0272 |
Bitewings - two radiographic images |
82 |
74 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
185 |
177 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$501.65 |
| D1208 |
Topical application of fluoride, excluding varnish |
32 |
31 |
$443.45 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$307.08 |
| D0603 |
|
40 |
40 |
$185.00 |
| D1999 |
|
19 |
16 |
$0.00 |