| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,579 |
2,556 |
$139K |
| D1110 |
Prophylaxis - adult |
1,466 |
1,454 |
$128K |
| D1120 |
Prophylaxis - child |
1,843 |
1,825 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
957 |
951 |
$63K |
| D0330 |
Panoramic radiographic image |
1,694 |
1,686 |
$51K |
| D1351 |
Sealant - per tooth |
1,798 |
439 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,477 |
3,444 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,387 |
1,362 |
$17K |
| D9430 |
|
346 |
332 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
181 |
121 |
$10K |
| D0274 |
Bitewings - four radiographic images |
323 |
323 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,517 |
281 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
249 |
246 |
$3K |