| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
157 |
157 |
$22K |
| D7240 |
Removal of impacted tooth - completely bony |
50 |
15 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
240 |
239 |
$7K |
| D1120 |
Prophylaxis - child |
172 |
170 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
395 |
297 |
$4K |
| D1206 |
Topical application of fluoride varnish |
278 |
275 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
337 |
332 |
$4K |
| D1110 |
Prophylaxis - adult |
58 |
57 |
$3K |
| D0272 |
Bitewings - two radiographic images |
132 |
131 |
$3K |
| D9248 |
|
26 |
26 |
$3K |
| D0274 |
Bitewings - four radiographic images |
58 |
57 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
16 |
$565.12 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
23 |
$431.48 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$211.63 |
| D0603 |
|
542 |
537 |
$0.00 |