| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,941 |
1,849 |
$63K |
| D0210 |
Intraoral - complete series of radiographic images |
820 |
802 |
$47K |
| D0330 |
Panoramic radiographic image |
930 |
917 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,482 |
1,440 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,244 |
2,055 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,825 |
1,768 |
$32K |
| D1206 |
Topical application of fluoride varnish |
515 |
498 |
$26K |
| D1120 |
Prophylaxis - child |
411 |
403 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
260 |
111 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
521 |
513 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
471 |
465 |
$12K |
| D1351 |
Sealant - per tooth |
433 |
69 |
$10K |
| D1110 |
Prophylaxis - adult |
267 |
260 |
$5K |
| D2950 |
|
34 |
12 |
$2K |
| D0603 |
|
12 |
12 |
$63.25 |
| D0601 |
|
12 |
12 |
$45.00 |