| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
878 |
876 |
$53K |
| D1110 |
Prophylaxis - adult |
632 |
632 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
286 |
82 |
$31K |
| D4341 |
|
425 |
119 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
406 |
406 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
419 |
416 |
$15K |
| D1120 |
Prophylaxis - child |
478 |
473 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,332 |
707 |
$10K |
| D3320 |
|
21 |
13 |
$8K |
| D1351 |
Sealant - per tooth |
261 |
63 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
285 |
285 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
17 |
$2K |
| D0272 |
Bitewings - two radiographic images |
213 |
213 |
$2K |
| D3221 |
|
29 |
29 |
$2K |
| D7111 |
|
31 |
31 |
$2K |
| D0330 |
Panoramic radiographic image |
75 |
74 |
$2K |
| D9248 |
|
18 |
15 |
$80.00 |