| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,110 |
1,080 |
$34K |
| D1120 |
Prophylaxis - child |
1,066 |
1,044 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,546 |
1,513 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,568 |
1,541 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
763 |
666 |
$18K |
| D0274 |
Bitewings - four radiographic images |
572 |
564 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
52 |
$6K |
| D0330 |
Panoramic radiographic image |
156 |
123 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
118 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
156 |
133 |
$1K |
| D0251 |
|
15 |
14 |
$819.90 |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$818.15 |