| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,554 |
1,506 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
571 |
304 |
$39K |
| D2954 |
|
253 |
194 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,432 |
1,395 |
$25K |
| D2335 |
|
312 |
200 |
$19K |
| D0330 |
Panoramic radiographic image |
528 |
507 |
$15K |
| D2161 |
|
282 |
233 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
1,414 |
1,356 |
$13K |
| D0272 |
Bitewings - two radiographic images |
651 |
626 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
769 |
652 |
$7K |
| D2332 |
|
122 |
82 |
$6K |
| D9110 |
|
157 |
139 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
45 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
232 |
229 |
$4K |
| D2160 |
|
72 |
56 |
$3K |
| D2140 |
|
64 |
40 |
$2K |