| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,668 |
1,213 |
$47K |
| D1999 |
|
1,978 |
1,526 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,434 |
1,033 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,490 |
1,078 |
$20K |
| D0330 |
Panoramic radiographic image |
383 |
312 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
505 |
366 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
233 |
205 |
$4K |
| D1120 |
Prophylaxis - child |
133 |
113 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$308.23 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$122.32 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$48.00 |