| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2161 |
|
150 |
90 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
160 |
101 |
$11K |
| D0330 |
Panoramic radiographic image |
245 |
243 |
$9K |
| D1110 |
Prophylaxis - adult |
185 |
184 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
289 |
$7K |
| D0274 |
Bitewings - four radiographic images |
205 |
204 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
85 |
$3K |
| D2335 |
|
24 |
17 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
117 |
117 |
$2K |
| D9110 |
|
77 |
71 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
212 |
208 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
15 |
$844.58 |
| D1120 |
Prophylaxis - child |
15 |
15 |
$654.16 |
| D0272 |
Bitewings - two radiographic images |
18 |
18 |
$295.61 |