| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,374 |
3,967 |
$219K |
| D0330 |
Panoramic radiographic image |
3,382 |
2,723 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
5,036 |
4,227 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,408 |
1,779 |
$97K |
| D1120 |
Prophylaxis - child |
2,400 |
2,373 |
$87K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
550 |
252 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,454 |
2,425 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,111 |
1,696 |
$40K |
| D1206 |
Topical application of fluoride varnish |
415 |
410 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
81 |
80 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$2K |