| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,735 |
1,642 |
$45K |
| D1999 |
|
1,615 |
1,521 |
$23K |
| D0330 |
Panoramic radiographic image |
577 |
538 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
783 |
734 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
1,125 |
1,058 |
$14K |
| D0272 |
Bitewings - two radiographic images |
962 |
918 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
351 |
316 |
$5K |
| D1120 |
Prophylaxis - child |
202 |
182 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
28 |
$789.30 |
| D2140 |
|
36 |
27 |
$777.60 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$252.00 |
| D2940 |
|
13 |
12 |
$197.00 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
28 |
$156.60 |