| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,168 |
2,144 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
664 |
630 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
156 |
94 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
178 |
176 |
$8K |
| D0274 |
Bitewings - four radiographic images |
224 |
221 |
$7K |
| D0330 |
Panoramic radiographic image |
115 |
114 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
104 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
408 |
104 |
$3K |
| D1206 |
Topical application of fluoride varnish |
115 |
113 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
58 |
56 |
$2K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$445.05 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$358.56 |
| D0190 |
|
12 |
12 |
$0.00 |