| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
759 |
699 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,603 |
1,520 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
487 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
258 |
137 |
$17K |
| D1110 |
Prophylaxis - adult |
417 |
417 |
$16K |
| D1206 |
Topical application of fluoride varnish |
589 |
589 |
$13K |
| D0274 |
Bitewings - four radiographic images |
416 |
416 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
962 |
902 |
$8K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
41 |
41 |
$1K |
| D1120 |
Prophylaxis - child |
31 |
31 |
$806.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$169.92 |