| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,693 |
2,494 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,712 |
1,599 |
$37K |
| D1999 |
|
2,047 |
1,773 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,023 |
1,881 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,618 |
1,765 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,390 |
1,264 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,015 |
1,869 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
306 |
226 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
85 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
364 |
312 |
$5K |
| D1120 |
Prophylaxis - child |
140 |
116 |
$3K |