| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,427 |
3,048 |
$106K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,879 |
3,660 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
3,907 |
3,662 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,258 |
2,150 |
$50K |
| D1120 |
Prophylaxis - child |
1,204 |
1,115 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
814 |
348 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,224 |
1,167 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
518 |
501 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,158 |
1,066 |
$11K |
| D1110 |
Prophylaxis - adult |
499 |
470 |
$10K |
| D1351 |
Sealant - per tooth |
251 |
54 |
$5K |
| D1206 |
Topical application of fluoride varnish |
59 |
58 |
$2K |
| D0272 |
Bitewings - two radiographic images |
64 |
56 |
$999.63 |
| D0602 |
|
15 |
15 |
$14.00 |
| D9215 |
|
27 |
14 |
$0.00 |