| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,713 |
1,464 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
3,564 |
1,859 |
$78K |
| D1206 |
Topical application of fluoride varnish |
2,101 |
1,024 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
683 |
364 |
$23K |
| D0272 |
Bitewings - two radiographic images |
720 |
363 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
103 |
$12K |
| D0330 |
Panoramic radiographic image |
164 |
132 |
$7K |
| D0274 |
Bitewings - four radiographic images |
162 |
80 |
$5K |
| D1120 |
Prophylaxis - child |
200 |
137 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
137 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
145 |
77 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
50 |
$1K |