| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,049 |
957 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
618 |
589 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,774 |
1,659 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,272 |
1,170 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
510 |
488 |
$14K |
| D1120 |
Prophylaxis - child |
308 |
294 |
$10K |
| D4355 |
|
91 |
88 |
$8K |
| D0274 |
Bitewings - four radiographic images |
249 |
230 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$203.83 |