| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
892 |
852 |
$21K |
| D1110 |
Prophylaxis - adult |
516 |
499 |
$18K |
| D0330 |
Panoramic radiographic image |
336 |
320 |
$11K |
| D0274 |
Bitewings - four radiographic images |
381 |
370 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
274 |
242 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
234 |
225 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
26 |
25 |
$1K |
| D1206 |
Topical application of fluoride varnish |
30 |
25 |
$237.75 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
24 |
$168.97 |