| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,619 |
1,605 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
1,676 |
1,668 |
$35K |
| D9110 |
|
754 |
731 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,817 |
1,772 |
$26K |
| D0274 |
Bitewings - four radiographic images |
579 |
575 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
867 |
799 |
$11K |
| D0330 |
Panoramic radiographic image |
134 |
130 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
12 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
70 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$1K |