| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
564 |
481 |
$14K |
| D1999 |
|
572 |
515 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
692 |
583 |
$8K |
| D0272 |
Bitewings - two radiographic images |
192 |
165 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
221 |
193 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
30 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
195 |
174 |
$993.10 |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
34 |
$450.34 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
29 |
$446.82 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
24 |
$377.32 |
| D1120 |
Prophylaxis - child |
21 |
20 |
$275.40 |