| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,831 |
2,774 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,125 |
3,081 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,231 |
2,212 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,504 |
1,467 |
$32K |
| D1120 |
Prophylaxis - child |
956 |
953 |
$30K |
| D0330 |
Panoramic radiographic image |
573 |
468 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
525 |
326 |
$10K |
| D9310 |
|
120 |
81 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
783 |
615 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$241.80 |