| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
742 |
678 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
637 |
574 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
217 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
83 |
40 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
125 |
122 |
$6K |
| D0330 |
Panoramic radiographic image |
78 |
76 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
178 |
$4K |
| D1120 |
Prophylaxis - child |
74 |
71 |
$2K |
| D0272 |
Bitewings - two radiographic images |
107 |
99 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
158 |
145 |
$1K |
| D0274 |
Bitewings - four radiographic images |
91 |
84 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
12 |
$598.35 |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
53 |
$458.56 |