| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,504 |
1,433 |
$34K |
| D1110 |
Prophylaxis - adult |
476 |
456 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
95 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
530 |
495 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
284 |
263 |
$4K |
| D0272 |
Bitewings - two radiographic images |
171 |
157 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
74 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
17 |
16 |
$663.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
14 |
$155.82 |