| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
438 |
436 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
417 |
416 |
$20K |
| D1120 |
Prophylaxis - child |
434 |
427 |
$14K |
| D0330 |
Panoramic radiographic image |
362 |
362 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,378 |
545 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
404 |
399 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
25 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
211 |
204 |
$2K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$2K |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$2K |
| D1999 |
|
46 |
43 |
$0.00 |