| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
383 |
380 |
$26K |
| D1110 |
Prophylaxis - adult |
269 |
267 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
301 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
739 |
613 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
52 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
349 |
342 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
84 |
$4K |
| D1120 |
Prophylaxis - child |
51 |
49 |
$3K |
| D4341 |
|
35 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
116 |
113 |
$1K |
| D1206 |
Topical application of fluoride varnish |
37 |
36 |
$539.00 |