| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,725 |
6,686 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,159 |
4,122 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
5,843 |
5,816 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
2,354 |
2,339 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
7,066 |
6,957 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,867 |
6,223 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,591 |
1,591 |
$8K |
| D0272 |
Bitewings - two radiographic images |
2,395 |
2,350 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
390 |
381 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
73 |
$2K |
| D4341 |
|
52 |
26 |
$1K |
| D1120 |
Prophylaxis - child |
59 |
59 |
$588.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
33 |
33 |
$280.00 |