| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,180 |
2,642 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
1,904 |
1,582 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,279 |
1,021 |
$22K |
| D1999 |
|
1,570 |
1,394 |
$17K |
| D0330 |
Panoramic radiographic image |
370 |
338 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
488 |
356 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
114 |
82 |
$4K |
| D2161 |
|
88 |
71 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
476 |
387 |
$3K |
| D1120 |
Prophylaxis - child |
162 |
113 |
$3K |
| D7250 |
|
48 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
383 |
232 |
$1K |
| D2335 |
|
23 |
15 |
$980.00 |
| D0140 |
Limited oral evaluation - problem focused |
20 |
13 |
$240.30 |