| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,741 |
1,633 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,194 |
2,054 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
673 |
638 |
$39K |
| D0274 |
Bitewings - four radiographic images |
932 |
880 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,311 |
1,238 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,251 |
2,033 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
939 |
825 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,656 |
1,137 |
$20K |
| D1120 |
Prophylaxis - child |
353 |
337 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
38 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
24 |
$864.74 |