| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,572 |
1,076 |
$21K |
| D9610 |
|
657 |
348 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
76 |
$7K |
| D1110 |
Prophylaxis - adult |
245 |
173 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,017 |
716 |
$5K |
| D1999 |
|
830 |
374 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
89 |
28 |
$3K |
| D1206 |
Topical application of fluoride varnish |
326 |
237 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
78 |
$2K |
| D0274 |
Bitewings - four radiographic images |
241 |
186 |
$1K |
| D9410 |
|
85 |
47 |
$1K |
| D9992 |
|
177 |
46 |
$840.00 |
| D0191 |
|
85 |
47 |
$390.00 |
| D0330 |
Panoramic radiographic image |
20 |
16 |
$248.40 |
| D0415 |
|
14 |
12 |
$236.39 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
17 |
$41.40 |