| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
975 |
899 |
$8K |
| D1110 |
Prophylaxis - adult |
577 |
565 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,191 |
1,827 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
945 |
917 |
$5K |
| D2750 |
|
144 |
86 |
$4K |
| D0330 |
Panoramic radiographic image |
453 |
438 |
$3K |
| D1120 |
Prophylaxis - child |
186 |
174 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
197 |
$1K |
| D2954 |
|
74 |
64 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$532.35 |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
67 |
$501.68 |
| D1208 |
Topical application of fluoride, excluding varnish |
164 |
160 |
$500.19 |
| D0274 |
Bitewings - four radiographic images |
72 |
71 |
$383.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
84 |
65 |
$242.86 |
| D0272 |
Bitewings - two radiographic images |
42 |
41 |
$153.45 |