| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
305 |
287 |
$11K |
| D0330 |
Panoramic radiographic image |
109 |
108 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
279 |
252 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
44 |
31 |
$2K |
| D1110 |
Prophylaxis - adult |
49 |
40 |
$847.00 |
| D0274 |
Bitewings - four radiographic images |
44 |
35 |
$366.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
34 |
$132.00 |