| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
841 |
785 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,287 |
1,192 |
$29K |
| D0330 |
Panoramic radiographic image |
345 |
340 |
$20K |
| D0274 |
Bitewings - four radiographic images |
632 |
600 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
323 |
315 |
$14K |
| D1120 |
Prophylaxis - child |
249 |
226 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
678 |
629 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
424 |
408 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
512 |
254 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
59 |
58 |
$2K |