| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
623 |
591 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
711 |
678 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
66 |
$6K |
| D0274 |
Bitewings - four radiographic images |
300 |
288 |
$6K |
| D0330 |
Panoramic radiographic image |
137 |
127 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
254 |
236 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
699 |
578 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
666 |
623 |
$3K |
| D1120 |
Prophylaxis - child |
106 |
96 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
72 |
67 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
76 |
$2K |
| D0272 |
Bitewings - two radiographic images |
23 |
22 |
$210.00 |