| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,398 |
1,348 |
$69K |
| D0330 |
Panoramic radiographic image |
646 |
610 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
813 |
772 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
516 |
486 |
$16K |
| D5214 |
|
18 |
15 |
$14K |
| D5213 |
|
13 |
13 |
$13K |
| D1206 |
Topical application of fluoride varnish |
247 |
243 |
$5K |
| D0272 |
Bitewings - two radiographic images |
233 |
227 |
$5K |
| D0274 |
Bitewings - four radiographic images |
101 |
99 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
13 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
109 |
103 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$393.85 |