| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,559 |
2,513 |
$65K |
| D1120 |
Prophylaxis - child |
1,164 |
1,151 |
$46K |
| D0330 |
Panoramic radiographic image |
1,279 |
1,255 |
$44K |
| D1110 |
Prophylaxis - adult |
1,021 |
1,004 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,869 |
1,854 |
$29K |
| D0274 |
Bitewings - four radiographic images |
830 |
818 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
333 |
195 |
$12K |
| D0272 |
Bitewings - two radiographic images |
657 |
649 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
350 |
334 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
632 |
602 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
314 |
243 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
17 |
15 |
$369.50 |
| D9987 |
|
273 |
224 |
$90.00 |