| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,030 |
1,956 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,783 |
2,689 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
837 |
785 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,252 |
2,164 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
421 |
58 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,352 |
1,314 |
$24K |
| D1120 |
Prophylaxis - child |
732 |
690 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,058 |
996 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,260 |
614 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
167 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
127 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
161 |
150 |
$3K |
| D0274 |
Bitewings - four radiographic images |
117 |
117 |
$2K |
| D0603 |
|
239 |
235 |
$1K |
| D1351 |
Sealant - per tooth |
36 |
12 |
$940.50 |
| D0330 |
Panoramic radiographic image |
29 |
28 |
$627.00 |