| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
908 |
902 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,685 |
1,668 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,294 |
1,279 |
$22K |
| D1120 |
Prophylaxis - child |
644 |
634 |
$20K |
| D0330 |
Panoramic radiographic image |
161 |
160 |
$6K |
| D0272 |
Bitewings - two radiographic images |
326 |
323 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
239 |
237 |
$5K |
| D2140 |
|
68 |
54 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |
| D9110 |
|
12 |
12 |
$585.00 |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
48 |
$560.42 |