| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
813 |
764 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
318 |
300 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
771 |
690 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
137 |
78 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
359 |
327 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
197 |
$6K |
| D0272 |
Bitewings - two radiographic images |
155 |
144 |
$3K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$826.28 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
14 |
$543.21 |
| D1999 |
|
16 |
14 |
$0.00 |