| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,791 |
5,594 |
$191K |
| D0330 |
Panoramic radiographic image |
3,884 |
3,282 |
$114K |
| D1999 |
|
6,326 |
5,433 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,018 |
3,429 |
$83K |
| D0272 |
Bitewings - two radiographic images |
5,707 |
4,806 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
4,926 |
4,056 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,538 |
1,264 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
643 |
559 |
$4K |
| D1120 |
Prophylaxis - child |
175 |
134 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
138 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
48 |
$2K |