| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
803 |
737 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
847 |
752 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
312 |
142 |
$18K |
| D0274 |
Bitewings - four radiographic images |
836 |
749 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
954 |
851 |
$12K |
| D1120 |
Prophylaxis - child |
244 |
217 |
$10K |
| D1206 |
Topical application of fluoride varnish |
276 |
244 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,034 |
829 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
155 |
$5K |
| D1110 |
Prophylaxis - adult |
187 |
162 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
13 |
$2K |
| D0602 |
|
112 |
107 |
$520.00 |
| D0601 |
|
27 |
25 |
$110.00 |