| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,642 |
1,595 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,829 |
1,346 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,832 |
1,781 |
$58K |
| D0330 |
Panoramic radiographic image |
1,920 |
1,152 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,243 |
1,156 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,196 |
1,166 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,990 |
1,835 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
863 |
849 |
$21K |
| D1120 |
Prophylaxis - child |
487 |
483 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,497 |
978 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
212 |
134 |
$16K |