| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
509 |
434 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
694 |
577 |
$18K |
| D0272 |
Bitewings - two radiographic images |
494 |
426 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
25 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
375 |
352 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
162 |
$7K |
| D1206 |
Topical application of fluoride varnish |
148 |
89 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
24 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
21 |
14 |
$361.00 |