| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,476 |
3,424 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
6,062 |
5,982 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,076 |
6,975 |
$144K |
| D1120 |
Prophylaxis - child |
4,077 |
4,012 |
$136K |
| D0330 |
Panoramic radiographic image |
1,975 |
1,937 |
$86K |
| D0272 |
Bitewings - two radiographic images |
4,360 |
4,290 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,113 |
1,092 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,808 |
1,630 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
242 |
140 |
$14K |
| D0274 |
Bitewings - four radiographic images |
159 |
158 |
$4K |
| D9110 |
|
16 |
14 |
$731.25 |