| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,764 |
1,658 |
$44K |
| D9110 |
|
1,252 |
1,189 |
$33K |
| D0330 |
Panoramic radiographic image |
807 |
781 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,894 |
1,771 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
372 |
223 |
$14K |
| D2335 |
|
158 |
65 |
$8K |
| D0274 |
Bitewings - four radiographic images |
377 |
344 |
$8K |
| D1110 |
Prophylaxis - adult |
145 |
145 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
897 |
554 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
91 |
$3K |
| D1120 |
Prophylaxis - child |
56 |
50 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
173 |
167 |
$2K |