| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
815 |
763 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
762 |
709 |
$14K |
| D0274 |
Bitewings - four radiographic images |
413 |
390 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
533 |
487 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
17 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
53 |
$2K |
| D1120 |
Prophylaxis - child |
56 |
55 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
133 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
66 |
$1K |
| D0272 |
Bitewings - two radiographic images |
54 |
53 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$443.64 |