| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,930 |
1,657 |
$223K |
| D0140 |
Limited oral evaluation - problem focused |
5,612 |
5,195 |
$154K |
| D0330 |
Panoramic radiographic image |
1,438 |
1,417 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
5,580 |
5,168 |
$57K |
| D1110 |
Prophylaxis - adult |
364 |
350 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
239 |
227 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
24 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
148 |
142 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
36 |
33 |
$355.90 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$268.73 |
| D0274 |
Bitewings - four radiographic images |
14 |
13 |
$57.30 |