| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,331 |
1,316 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
2,022 |
1,987 |
$105K |
| D1120 |
Prophylaxis - child |
938 |
926 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,495 |
2,470 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
295 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,961 |
649 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
176 |
175 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
594 |
590 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
37 |
$5K |
| D0274 |
Bitewings - four radiographic images |
176 |
175 |
$4K |