| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
593 |
576 |
$12K |
| D5110 |
|
78 |
63 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
424 |
69 |
$11K |
| D5120 |
|
50 |
41 |
$9K |
| D0330 |
Panoramic radiographic image |
244 |
232 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
151 |
135 |
$5K |
| D1206 |
Topical application of fluoride varnish |
275 |
274 |
$4K |
| D1110 |
Prophylaxis - adult |
110 |
106 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
138 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
166 |
166 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
352 |
337 |
$2K |
| D1120 |
Prophylaxis - child |
53 |
53 |
$980.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
93 |
$420.00 |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$280.00 |