| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
570 |
382 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
660 |
617 |
$21K |
| D1110 |
Prophylaxis - adult |
361 |
359 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
763 |
648 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
681 |
677 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
668 |
665 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
92 |
42 |
$11K |
| D0274 |
Bitewings - four radiographic images |
325 |
322 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
836 |
727 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$8K |
| D1120 |
Prophylaxis - child |
228 |
227 |
$7K |
| D0330 |
Panoramic radiographic image |
173 |
128 |
$7K |
| D8670 |
Periodic orthodontic treatment visit |
16 |
14 |
$7K |
| D9630 |
|
118 |
118 |
$3K |
| D4910 |
|
12 |
12 |
$830.52 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$241.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
12 |
$234.78 |