| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
926 |
780 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
796 |
670 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
540 |
444 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
308 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
199 |
142 |
$5K |
| D1120 |
Prophylaxis - child |
192 |
155 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
249 |
214 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
394 |
337 |
$2K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$850.34 |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
45 |
$232.90 |