| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,334 |
1,330 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,280 |
1,276 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
549 |
546 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,162 |
1,156 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
89 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
341 |
340 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
748 |
737 |
$3K |
| D1120 |
Prophylaxis - child |
125 |
124 |
$2K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
368 |
231 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
43 |
$993.52 |
| D1206 |
Topical application of fluoride varnish |
57 |
57 |
$840.00 |
| D0210 |
Intraoral - complete series of radiographic images |
35 |
25 |
$481.52 |
| D0274 |
Bitewings - four radiographic images |
21 |
21 |
$240.00 |