| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
169 |
142 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
19 |
$3K |
| D0274 |
Bitewings - four radiographic images |
113 |
111 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
49 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
105 |
100 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
138 |
111 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
146 |
$2K |
| D1120 |
Prophylaxis - child |
60 |
55 |
$2K |
| D1110 |
Prophylaxis - adult |
59 |
57 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
44 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$434.89 |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
27 |
$398.33 |