| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,129 |
1,100 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,895 |
1,844 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,181 |
1,154 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,046 |
1,017 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
138 |
38 |
$10K |
| D1120 |
Prophylaxis - child |
232 |
224 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
432 |
407 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
231 |
214 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
57 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
68 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
170 |
129 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$1K |
| D0602 |
|
291 |
280 |
$1K |
| D0603 |
|
193 |
180 |
$660.00 |
| D0274 |
Bitewings - four radiographic images |
19 |
17 |
$296.40 |
| D0601 |
|
26 |
26 |
$125.00 |