| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,438 |
3,315 |
$61K |
| D1110 |
Prophylaxis - adult |
1,651 |
1,588 |
$58K |
| D1120 |
Prophylaxis - child |
2,120 |
2,041 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,343 |
3,234 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,522 |
1,466 |
$26K |
| D1999 |
|
1,254 |
1,128 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
210 |
130 |
$11K |
| D0274 |
Bitewings - four radiographic images |
266 |
260 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
259 |
243 |
$5K |
| D0330 |
Panoramic radiographic image |
83 |
81 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
250 |
231 |
$3K |
| D1206 |
Topical application of fluoride varnish |
22 |
19 |
$320.00 |