| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
789 |
766 |
$26K |
| D2752 |
|
51 |
39 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
870 |
843 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
553 |
534 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
174 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
345 |
322 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
868 |
749 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
375 |
363 |
$6K |
| D0272 |
Bitewings - two radiographic images |
523 |
504 |
$5K |
| D2950 |
|
51 |
45 |
$5K |
| D0330 |
Panoramic radiographic image |
370 |
351 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
30 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
115 |
75 |
$610.44 |