| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
842 |
746 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
615 |
527 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
683 |
609 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
445 |
373 |
$7K |
| D1120 |
Prophylaxis - child |
361 |
309 |
$6K |
| D0272 |
Bitewings - two radiographic images |
333 |
293 |
$5K |
| D2140 |
|
113 |
40 |
$3K |
| D1999 |
|
212 |
169 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
60 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
375 |
327 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
198 |
120 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
32 |
$577.89 |