| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,894 |
2,798 |
$126K |
| D1206 |
Topical application of fluoride varnish |
2,923 |
2,825 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
1,988 |
1,806 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,239 |
4,376 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,918 |
1,860 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,359 |
3,172 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,907 |
1,827 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,693 |
1,612 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
909 |
872 |
$29K |
| D1110 |
Prophylaxis - adult |
504 |
479 |
$10K |
| D0601 |
|
1,447 |
1,409 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
80 |
$7K |
| D0160 |
|
171 |
165 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
52 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
84 |
84 |
$3K |
| D9110 |
|
79 |
69 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
84 |
84 |
$2K |
| D4355 |
|
18 |
16 |
$105.00 |