| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
194 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
27 |
$8K |
| D1120 |
Prophylaxis - child |
260 |
238 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
72 |
60 |
$2K |
| D1206 |
Topical application of fluoride varnish |
103 |
97 |
$2K |
| D0330 |
Panoramic radiographic image |
55 |
46 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
43 |
$457.58 |
| D0274 |
Bitewings - four radiographic images |
15 |
13 |
$259.48 |