| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,321 |
1,159 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
738 |
692 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,131 |
1,851 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
397 |
393 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,701 |
1,227 |
$18K |
| D0330 |
Panoramic radiographic image |
490 |
426 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
798 |
724 |
$12K |
| D1120 |
Prophylaxis - child |
258 |
246 |
$10K |
| D1206 |
Topical application of fluoride varnish |
337 |
319 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
405 |
376 |
$10K |
| D1351 |
Sealant - per tooth |
175 |
27 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
26 |
$4K |