| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
913 |
898 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,271 |
1,247 |
$27K |
| D1110 |
Prophylaxis - adult |
520 |
508 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
926 |
915 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
200 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
252 |
227 |
$7K |
| D0272 |
Bitewings - two radiographic images |
170 |
163 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
13 |
$888.78 |
| D0274 |
Bitewings - four radiographic images |
16 |
13 |
$412.16 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$156.98 |