| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,229 |
1,937 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,142 |
786 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,708 |
1,481 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,325 |
1,137 |
$24K |
| D1999 |
|
1,536 |
1,341 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,207 |
1,029 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,159 |
1,013 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,101 |
643 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
208 |
155 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
20 |
16 |
$324.04 |
| D1120 |
Prophylaxis - child |
18 |
16 |
$301.40 |