| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
307 |
145 |
$4K |
| D1120 |
Prophylaxis - child |
158 |
91 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
274 |
120 |
$2K |
| D1206 |
Topical application of fluoride varnish |
153 |
89 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
132 |
36 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
337 |
164 |
$948.52 |
| D9420 |
|
28 |
26 |
$942.77 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
135 |
59 |
$864.24 |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
14 |
$500.18 |
| D0220 |
Intraoral - periapical first radiographic image |
90 |
44 |
$424.86 |
| D0120 |
Periodic oral evaluation - established patient |
29 |
16 |
$350.00 |