| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
229 |
61 |
$13K |
| D0330 |
Panoramic radiographic image |
237 |
199 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
340 |
296 |
$8K |
| D1110 |
Prophylaxis - adult |
149 |
136 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
115 |
$3K |
| D0274 |
Bitewings - four radiographic images |
93 |
80 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
118 |
76 |
$925.38 |
| D0120 |
Periodic oral evaluation - established patient |
72 |
67 |
$778.99 |
| D1208 |
Topical application of fluoride, excluding varnish |
91 |
80 |
$761.26 |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
44 |
$242.48 |