| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
438 |
421 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
743 |
693 |
$15K |
| D1206 |
Topical application of fluoride varnish |
641 |
592 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
302 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
155 |
145 |
$7K |
| D1120 |
Prophylaxis - child |
166 |
149 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
14 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
52 |
$2K |
| D0330 |
Panoramic radiographic image |
18 |
17 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$422.04 |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
100 |
$376.60 |