| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,006 |
987 |
$55K |
| D9110 |
|
767 |
725 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,136 |
1,119 |
$26K |
| D0330 |
Panoramic radiographic image |
445 |
437 |
$23K |
| D0272 |
Bitewings - two radiographic images |
839 |
825 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
934 |
875 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
72 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
294 |
289 |
$8K |
| D2140 |
|
23 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$510.00 |