| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,221 |
1,101 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
992 |
892 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,084 |
990 |
$19K |
| D0330 |
Panoramic radiographic image |
1,133 |
1,002 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
556 |
457 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
235 |
208 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
123 |
100 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
768 |
386 |
$1K |
| D7250 |
|
147 |
53 |
$0.00 |
| D7311 |
|
192 |
103 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
441 |
184 |
$0.00 |