| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,604 |
1,593 |
$134K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,776 |
1,771 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
1,749 |
1,743 |
$97K |
| D0330 |
Panoramic radiographic image |
1,923 |
1,918 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,771 |
2,535 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,450 |
2,437 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
216 |
151 |
$25K |
| D1120 |
Prophylaxis - child |
476 |
475 |
$17K |
| D0272 |
Bitewings - two radiographic images |
987 |
976 |
$11K |
| D0350 |
|
202 |
116 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
124 |
120 |
$1K |
| D9110 |
|
15 |
14 |
$882.00 |
| D1999 |
|
36 |
33 |
$46.00 |