| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,174 |
1,134 |
$29K |
| D1110 |
Prophylaxis - adult |
615 |
584 |
$25K |
| D0330 |
Panoramic radiographic image |
566 |
546 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,237 |
1,187 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
431 |
408 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
66 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
269 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
141 |
138 |
$2K |
| D1120 |
Prophylaxis - child |
43 |
41 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
34 |
34 |
$935.00 |