| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
850 |
676 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
886 |
690 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
65 |
$14K |
| D0272 |
Bitewings - two radiographic images |
709 |
587 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
216 |
203 |
$7K |
| D0330 |
Panoramic radiographic image |
141 |
90 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
175 |
125 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
36 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
56 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
40 |
$855.00 |
| D0601 |
|
40 |
36 |
$130.00 |