| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
392 |
348 |
$7K |
| D1110 |
Prophylaxis - adult |
181 |
167 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
259 |
245 |
$6K |
| D0274 |
Bitewings - four radiographic images |
110 |
102 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
15 |
$2K |
| D1120 |
Prophylaxis - child |
45 |
40 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
40 |
$1K |
| D1206 |
Topical application of fluoride varnish |
44 |
38 |
$501.00 |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
46 |
$302.64 |