| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,543 |
1,445 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,433 |
1,338 |
$26K |
| D0330 |
Panoramic radiographic image |
436 |
396 |
$17K |
| D0274 |
Bitewings - four radiographic images |
384 |
344 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
223 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
26 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
149 |
138 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
163 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
169 |
$1K |
| D1120 |
Prophylaxis - child |
28 |
26 |
$0.00 |