| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,400 |
1,264 |
$44K |
| D1120 |
Prophylaxis - child |
1,756 |
1,567 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,302 |
1,116 |
$29K |
| D0330 |
Panoramic radiographic image |
671 |
581 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
629 |
551 |
$19K |
| D1351 |
Sealant - per tooth |
730 |
120 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,439 |
1,263 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
69 |
$13K |
| D1206 |
Topical application of fluoride varnish |
229 |
215 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
242 |
187 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
162 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$1K |
| D1999 |
|
1,185 |
951 |
$0.00 |
| D1330 |
|
1,304 |
1,068 |
$0.00 |