| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,085 |
1,056 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,053 |
998 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
248 |
240 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
318 |
309 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
897 |
858 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
543 |
534 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63 |
42 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
513 |
306 |
$6K |
| D0274 |
Bitewings - four radiographic images |
70 |
69 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
78 |
$2K |
| D1120 |
Prophylaxis - child |
17 |
17 |
$825.00 |
| D1999 |
|
16 |
15 |
$0.00 |