| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
895 |
867 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,070 |
1,043 |
$20K |
| D0274 |
Bitewings - four radiographic images |
653 |
633 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
259 |
135 |
$13K |
| D0330 |
Panoramic radiographic image |
194 |
193 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
176 |
174 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
228 |
217 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
125 |
113 |
$1K |
| D9110 |
|
15 |
14 |
$443.40 |