| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,448 |
1,421 |
$34K |
| D0330 |
Panoramic radiographic image |
769 |
753 |
$31K |
| D1110 |
Prophylaxis - adult |
748 |
733 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
970 |
947 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
606 |
596 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
271 |
260 |
$9K |
| D0350 |
|
267 |
246 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
127 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
52 |
52 |
$2K |
| D1206 |
Topical application of fluoride varnish |
64 |
54 |
$2K |
| D0502 |
|
20 |
19 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
138 |
128 |
$759.81 |
| D4355 |
|
63 |
57 |
$630.00 |
| D9630 |
|
75 |
67 |
$190.00 |
| D0460 |
|
16 |
15 |
$30.75 |