| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
132 |
130 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
138 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
35 |
$3K |
| D1110 |
Prophylaxis - adult |
83 |
82 |
$3K |
| D1351 |
Sealant - per tooth |
100 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
81 |
$2K |
| D0330 |
Panoramic radiographic image |
48 |
48 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
71 |
$1K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$916.53 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$277.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
14 |
$99.73 |