| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
520 |
436 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
373 |
316 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
314 |
269 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
225 |
203 |
$3K |
| D2140 |
|
69 |
27 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
245 |
213 |
$1K |
| D1120 |
Prophylaxis - child |
81 |
81 |
$1K |
| D1999 |
|
74 |
60 |
$629.91 |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$448.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
113 |
79 |
$408.15 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$74.47 |