| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,268 |
1,183 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,429 |
1,300 |
$43K |
| D1120 |
Prophylaxis - child |
806 |
761 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,237 |
1,156 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,660 |
1,540 |
$19K |
| D0274 |
Bitewings - four radiographic images |
879 |
801 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
639 |
593 |
$18K |
| D1206 |
Topical application of fluoride varnish |
515 |
483 |
$16K |
| D1351 |
Sealant - per tooth |
624 |
109 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,746 |
1,484 |
$11K |
| D1110 |
Prophylaxis - adult |
435 |
417 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
73 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
243 |
233 |
$2K |
| D1353 |
|
52 |
12 |
$836.40 |
| D0999 |
Unspecified diagnostic procedure, by report |
23 |
23 |
$690.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
23 |
23 |
$460.00 |
| D5899 |
|
28 |
12 |
$205.00 |
| D0601 |
|
33 |
28 |
$135.00 |
| D0270 |
|
13 |
13 |
$106.11 |