| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,204 |
1,146 |
$101K |
| D1110 |
Prophylaxis - adult |
1,570 |
1,511 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,325 |
1,264 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
374 |
174 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
755 |
736 |
$17K |
| D0274 |
Bitewings - four radiographic images |
95 |
94 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
85 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$522.80 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$364.45 |