| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,808 |
1,792 |
$118K |
| D9430 |
|
2,211 |
1,820 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,248 |
1,238 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
764 |
753 |
$45K |
| D0350 |
|
4,061 |
953 |
$38K |
| D1120 |
Prophylaxis - child |
775 |
768 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,338 |
1,574 |
$25K |
| D1110 |
Prophylaxis - adult |
269 |
265 |
$23K |
| D0274 |
Bitewings - four radiographic images |
679 |
671 |
$13K |
| D0330 |
Panoramic radiographic image |
390 |
389 |
$11K |
| D1206 |
Topical application of fluoride varnish |
697 |
690 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
480 |
480 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
47 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
66 |
$760.00 |
| D0270 |
|
147 |
134 |
$735.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$108.00 |
| D1330 |
|
16 |
16 |
$0.00 |