| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
322 |
264 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
475 |
372 |
$11K |
| D1110 |
Prophylaxis - adult |
91 |
90 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
144 |
140 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
56 |
55 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
35 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
33 |
25 |
$302.46 |
| D9630 |
|
17 |
13 |
$195.00 |