| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,110 |
2,689 |
$84K |
| D1999 |
|
3,110 |
2,743 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,430 |
2,083 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,654 |
1,389 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,821 |
1,585 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,742 |
1,478 |
$24K |
| D0330 |
Panoramic radiographic image |
779 |
716 |
$24K |
| D1351 |
Sealant - per tooth |
1,254 |
128 |
$17K |
| D1120 |
Prophylaxis - child |
883 |
746 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
201 |
113 |
$5K |
| D2140 |
|
168 |
87 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
148 |
106 |
$688.48 |