| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
489 |
478 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
586 |
572 |
$10K |
| D0330 |
Panoramic radiographic image |
117 |
112 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
63 |
$5K |
| D0274 |
Bitewings - four radiographic images |
142 |
137 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
120 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
374 |
359 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
364 |
306 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
97 |
$2K |
| D1120 |
Prophylaxis - child |
56 |
51 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$1K |