| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,030 |
3,842 |
$203K |
| D0120 |
Periodic oral evaluation - established patient |
4,094 |
3,960 |
$93K |
| D8670 |
Periodic orthodontic treatment visit |
296 |
271 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
357 |
305 |
$22K |
| D0274 |
Bitewings - four radiographic images |
513 |
481 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
407 |
396 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
279 |
$11K |
| D1120 |
Prophylaxis - child |
181 |
177 |
$9K |
| D1206 |
Topical application of fluoride varnish |
320 |
317 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
28 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
488 |
464 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
107 |
$5K |
| D7311 |
|
18 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$2K |