| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,747 |
3,490 |
$99K |
| D1999 |
|
4,586 |
4,307 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
4,050 |
3,819 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,897 |
2,707 |
$40K |
| D1120 |
Prophylaxis - child |
1,714 |
1,603 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,314 |
1,183 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
856 |
813 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
221 |
$3K |
| D2940 |
|
95 |
91 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
175 |
74 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
38 |
$1K |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$705.47 |