| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,034 |
1,025 |
$41K |
| D1110 |
Prophylaxis - adult |
366 |
363 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
346 |
340 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
316 |
163 |
$16K |
| D1120 |
Prophylaxis - child |
530 |
527 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
237 |
233 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,289 |
1,017 |
$9K |
| D0272 |
Bitewings - two radiographic images |
579 |
577 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
498 |
493 |
$5K |
| D1351 |
Sealant - per tooth |
55 |
15 |
$1K |
| D0274 |
Bitewings - four radiographic images |
62 |
62 |
$1K |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$290.00 |
| D1330 |
|
224 |
224 |
$0.00 |