| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,773 |
1,691 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,364 |
2,249 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
399 |
185 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
345 |
$14K |
| D1120 |
Prophylaxis - child |
426 |
402 |
$12K |
| D0272 |
Bitewings - two radiographic images |
474 |
463 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
65 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
373 |
361 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
178 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
87 |
80 |
$5K |
| D1206 |
Topical application of fluoride varnish |
249 |
213 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
343 |
306 |
$4K |
| D0274 |
Bitewings - four radiographic images |
112 |
102 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
14 |
$277.78 |