| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
532 |
528 |
$26K |
| D0330 |
Panoramic radiographic image |
585 |
577 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
571 |
565 |
$16K |
| D1110 |
Prophylaxis - adult |
336 |
333 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
335 |
200 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
39 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
99 |
$4K |
| D1120 |
Prophylaxis - child |
378 |
377 |
$628.79 |
| D0272 |
Bitewings - two radiographic images |
141 |
135 |
$7.00 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
18 |
$4.00 |
| D1330 |
|
778 |
774 |
$3.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
682 |
678 |
$0.00 |