| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,509 |
1,499 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,318 |
1,313 |
$75K |
| D1206 |
Topical application of fluoride varnish |
1,886 |
1,884 |
$28K |
| D0330 |
Panoramic radiographic image |
947 |
943 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
287 |
285 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
396 |
394 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
827 |
424 |
$3K |
| D0274 |
Bitewings - four radiographic images |
123 |
123 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
65 |
$828.00 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$735.00 |
| D9430 |
|
13 |
12 |
$416.00 |