| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
587 |
548 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
501 |
460 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
426 |
389 |
$12K |
| D1110 |
Prophylaxis - adult |
349 |
330 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
465 |
434 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,247 |
1,155 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
139 |
28 |
$8K |
| D1999 |
|
349 |
302 |
$4K |
| D0274 |
Bitewings - four radiographic images |
260 |
247 |
$3K |
| D9110 |
|
70 |
68 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
892 |
520 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
96 |
$1K |