| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,184 |
1,184 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
472 |
244 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,665 |
1,665 |
$37K |
| D0330 |
Panoramic radiographic image |
661 |
661 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,069 |
1,069 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
692 |
691 |
$26K |
| D1120 |
Prophylaxis - child |
683 |
683 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,403 |
1,403 |
$23K |
| D0272 |
Bitewings - two radiographic images |
865 |
865 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
224 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
217 |
216 |
$3K |