| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,314 |
1,267 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,533 |
1,469 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,305 |
1,258 |
$32K |
| D0274 |
Bitewings - four radiographic images |
597 |
562 |
$10K |
| D1110 |
Prophylaxis - adult |
190 |
178 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
114 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
345 |
329 |
$2K |
| D0272 |
Bitewings - two radiographic images |
170 |
169 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$586.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
68 |
$402.80 |