| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,363 |
2,298 |
$87K |
| D0330 |
Panoramic radiographic image |
1,253 |
961 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,135 |
1,669 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,044 |
1,033 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
182 |
88 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
605 |
585 |
$12K |
| D0274 |
Bitewings - four radiographic images |
527 |
519 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
129 |
41 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
557 |
357 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
61 |
$1K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$435.76 |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
56 |
$0.00 |