| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
998 |
967 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
955 |
932 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
621 |
603 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
175 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
158 |
150 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
215 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
39 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
13 |
$3K |
| D0274 |
Bitewings - four radiographic images |
58 |
56 |
$2K |