| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
406 |
386 |
$18K |
| D1110 |
Prophylaxis - adult |
430 |
414 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
702 |
682 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
436 |
422 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
150 |
65 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
431 |
422 |
$6K |
| D1120 |
Prophylaxis - child |
236 |
232 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
52 |
$3K |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$150.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
25 |
$120.00 |