| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
842 |
753 |
$18K |
| D1110 |
Prophylaxis - adult |
394 |
360 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
523 |
476 |
$8K |
| D0272 |
Bitewings - two radiographic images |
498 |
454 |
$7K |
| D1120 |
Prophylaxis - child |
209 |
177 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
59 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
69 |
$2K |
| D0330 |
Panoramic radiographic image |
147 |
129 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
183 |
164 |
$2K |
| D2140 |
|
16 |
13 |
$986.35 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
32 |
$0.00 |