| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,941 |
1,939 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,893 |
1,890 |
$57K |
| D1110 |
Prophylaxis - adult |
1,078 |
1,075 |
$50K |
| D4346 |
|
393 |
393 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,169 |
2,166 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,511 |
2,458 |
$29K |
| D2394 |
|
226 |
166 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,216 |
2,152 |
$21K |
| D1120 |
Prophylaxis - child |
546 |
546 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
253 |
252 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
38 |
$6K |
| D2335 |
|
19 |
14 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
24 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
85 |
84 |
$2K |
| D0272 |
Bitewings - two radiographic images |
54 |
54 |
$1K |