| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,190 |
3,851 |
$108K |
| D0330 |
Panoramic radiographic image |
2,614 |
2,354 |
$71K |
| D1999 |
|
3,611 |
3,348 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,421 |
3,127 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
3,079 |
2,848 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,092 |
1,882 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,557 |
1,381 |
$21K |
| D1120 |
Prophylaxis - child |
733 |
639 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
238 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
26 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
18 |
$150.45 |