| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,702 |
1,661 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
691 |
434 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,520 |
2,461 |
$59K |
| D0330 |
Panoramic radiographic image |
575 |
563 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,427 |
1,402 |
$32K |
| D1120 |
Prophylaxis - child |
867 |
854 |
$26K |
| D0274 |
Bitewings - four radiographic images |
743 |
717 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
293 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
137 |
133 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
312 |
305 |
$3K |
| D0272 |
Bitewings - two radiographic images |
67 |
67 |
$943.19 |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
45 |
$464.40 |
| D1999 |
|
40 |
32 |
$0.00 |