| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
322 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,778 |
772 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
392 |
387 |
$16K |
| D1120 |
Prophylaxis - child |
406 |
400 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
164 |
160 |
$7K |
| D0274 |
Bitewings - four radiographic images |
382 |
376 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
467 |
461 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
15 |
$4K |
| D1110 |
Prophylaxis - adult |
17 |
17 |
$2K |
| D1351 |
Sealant - per tooth |
68 |
26 |
$1K |
| D0350 |
|
46 |
45 |
$1K |
| D9430 |
|
39 |
33 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
104 |
104 |
$1K |
| D0272 |
Bitewings - two radiographic images |
78 |
78 |
$924.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$826.00 |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
56 |
$672.00 |