| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
159 |
159 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
288 |
288 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
255 |
255 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
416 |
407 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
78 |
$4K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
85 |
84 |
$4K |
| D0274 |
Bitewings - four radiographic images |
125 |
124 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
259 |
234 |
$3K |