| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,335 |
1,088 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
916 |
333 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,050 |
890 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,118 |
1,695 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
556 |
448 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
399 |
315 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
764 |
610 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
966 |
812 |
$8K |
| D0272 |
Bitewings - two radiographic images |
304 |
295 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
165 |
154 |
$3K |
| D0274 |
Bitewings - four radiographic images |
178 |
145 |
$2K |
| D1120 |
Prophylaxis - child |
26 |
24 |
$929.36 |