| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,146 |
2,766 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
2,611 |
2,370 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,536 |
1,334 |
$60K |
| D0330 |
Panoramic radiographic image |
969 |
866 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,868 |
1,553 |
$40K |
| D1120 |
Prophylaxis - child |
518 |
510 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
225 |
217 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
497 |
485 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
28 |
$3K |
| D0272 |
Bitewings - two radiographic images |
141 |
140 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
146 |
132 |
$2K |
| D1206 |
Topical application of fluoride varnish |
64 |
62 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$136.44 |