| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,015 |
1,931 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,204 |
655 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,770 |
1,685 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,273 |
1,223 |
$37K |
| D1110 |
Prophylaxis - adult |
756 |
723 |
$25K |
| D1120 |
Prophylaxis - child |
571 |
552 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,012 |
972 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,153 |
1,089 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
38 |
$3K |
| D0272 |
Bitewings - two radiographic images |
131 |
125 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
27 |
27 |
$729.00 |