| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,728 |
1,589 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,715 |
2,578 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
211 |
124 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
1,109 |
1,084 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
166 |
$5K |
| D0274 |
Bitewings - four radiographic images |
553 |
547 |
$4K |
| D1110 |
Prophylaxis - adult |
201 |
198 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,266 |
1,097 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
381 |
376 |
$3K |
| D0330 |
Panoramic radiographic image |
188 |
182 |
$2K |
| D7250 |
|
20 |
12 |
$933.21 |
| D2950 |
|
19 |
13 |
$564.95 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$297.45 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$206.52 |