| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
473 |
468 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
113 |
$15K |
| D0330 |
Panoramic radiographic image |
233 |
233 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
303 |
299 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
156 |
156 |
$3K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$1K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$705.60 |
| D0120 |
Periodic oral evaluation - established patient |
30 |
30 |
$667.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$452.40 |