| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
874 |
733 |
$34K |
| D0330 |
Panoramic radiographic image |
456 |
413 |
$28K |
| D1110 |
Prophylaxis - adult |
471 |
436 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
125 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
278 |
246 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,282 |
1,054 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
136 |
86 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
446 |
412 |
$10K |
| D0274 |
Bitewings - four radiographic images |
196 |
193 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
486 |
429 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
145 |
131 |
$4K |
| D9110 |
|
38 |
36 |
$2K |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$781.88 |
| D0460 |
|
15 |
12 |
$382.80 |
| D0431 |
|
344 |
326 |
$0.00 |
| D1999 |
|
22 |
16 |
$0.00 |