| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,156 |
2,137 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,621 |
866 |
$86K |
| D1120 |
Prophylaxis - child |
1,311 |
1,302 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,994 |
1,980 |
$54K |
| D0330 |
Panoramic radiographic image |
1,010 |
1,000 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,442 |
1,428 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,671 |
1,660 |
$28K |
| D0272 |
Bitewings - two radiographic images |
780 |
771 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
580 |
568 |
$5K |
| D2140 |
|
106 |
92 |
$4K |