| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,875 |
2,310 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,767 |
2,256 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
2,366 |
1,877 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,210 |
487 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,910 |
1,487 |
$46K |
| D0274 |
Bitewings - four radiographic images |
733 |
582 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,007 |
863 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
201 |
193 |
$7K |
| D1120 |
Prophylaxis - child |
141 |
141 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
29 |
$4K |
| D0272 |
Bitewings - two radiographic images |
173 |
165 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
158 |
148 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
46 |
$368.36 |