| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,185 |
1,026 |
$83K |
| D0274 |
Bitewings - four radiographic images |
1,492 |
1,310 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
2,543 |
1,870 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,930 |
1,395 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
812 |
729 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,376 |
1,231 |
$28K |
| D0330 |
Panoramic radiographic image |
427 |
383 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
751 |
675 |
$26K |
| D1351 |
Sealant - per tooth |
393 |
28 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
302 |
$17K |
| D1120 |
Prophylaxis - child |
126 |
119 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
12 |
$3K |