| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,056 |
1,018 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
844 |
823 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
905 |
770 |
$16K |
| D9110 |
|
412 |
324 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
281 |
93 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,156 |
1,119 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
291 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
808 |
769 |
$5K |
| D0272 |
Bitewings - two radiographic images |
397 |
389 |
$3K |
| D1351 |
Sealant - per tooth |
94 |
13 |
$2K |
| D2160 |
|
33 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
152 |
$386.67 |
| D0190 |
|
21 |
20 |
$0.00 |