| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,234 |
1,234 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
571 |
316 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,338 |
1,338 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
948 |
945 |
$34K |
| D0330 |
Panoramic radiographic image |
684 |
684 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
734 |
734 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,113 |
1,113 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,420 |
1,420 |
$23K |
| D1120 |
Prophylaxis - child |
644 |
644 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,643 |
1,611 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
943 |
917 |
$9K |
| D0272 |
Bitewings - two radiographic images |
100 |
100 |
$2K |