| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,878 |
1,872 |
$103K |
| D1120 |
Prophylaxis - child |
1,053 |
1,051 |
$38K |
| D1110 |
Prophylaxis - adult |
356 |
354 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,249 |
1,244 |
$27K |
| D0240 |
|
1,834 |
916 |
$18K |
| D4341 |
|
232 |
83 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,299 |
1,169 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
304 |
304 |
$14K |
| D9430 |
|
448 |
425 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,065 |
1,062 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
144 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,101 |
1,175 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
51 |
$5K |
| D4910 |
|
28 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
57 |
56 |
$652.00 |