| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
3,860 |
3,445 |
$198K |
| D1110 |
Prophylaxis - adult |
3,838 |
3,417 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,772 |
5,076 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
5,052 |
4,379 |
$101K |
| D1206 |
Topical application of fluoride varnish |
3,521 |
3,145 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
25 |
$6K |
| D1354 |
|
253 |
73 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
42 |
$976.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
12 |
$403.85 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
25 |
$320.25 |
| D1330 |
|
1,109 |
1,032 |
$0.00 |