| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,014 |
1,014 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,282 |
1,282 |
$24K |
| D0274 |
Bitewings - four radiographic images |
835 |
834 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
125 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
559 |
554 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
136 |
136 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
564 |
563 |
$2K |
| D1120 |
Prophylaxis - child |
56 |
56 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
32 |
32 |
$334.46 |