| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
436 |
427 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
100 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
380 |
373 |
$6K |
| D0274 |
Bitewings - four radiographic images |
246 |
240 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
531 |
520 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
92 |
$2K |
| D0272 |
Bitewings - two radiographic images |
188 |
184 |
$2K |
| D1120 |
Prophylaxis - child |
49 |
48 |
$914.00 |
| D2140 |
|
21 |
12 |
$900.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
26 |
$130.00 |