| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
357 |
355 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
588 |
586 |
$16K |
| D1120 |
Prophylaxis - child |
362 |
360 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
457 |
455 |
$9K |
| D0272 |
Bitewings - two radiographic images |
419 |
417 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
163 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
30 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
316 |
272 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
129 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
16 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
27 |
$195.15 |