| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,663 |
1,596 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,345 |
1,265 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
899 |
854 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,520 |
1,438 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,182 |
2,086 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
920 |
890 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,428 |
2,195 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
213 |
66 |
$24K |
| D0274 |
Bitewings - four radiographic images |
589 |
586 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,322 |
1,001 |
$3K |
| D0330 |
Panoramic radiographic image |
75 |
74 |
$3K |
| D9110 |
|
12 |
12 |
$955.33 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$275.76 |