| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
470 |
408 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
128 |
77 |
$12K |
| T1015 |
Clinic visit/encounter, all-inclusive |
23 |
12 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
457 |
381 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
14 |
$3K |
| D1110 |
Prophylaxis - adult |
25 |
24 |
$1K |
| D1206 |
Topical application of fluoride varnish |
48 |
39 |
$681.00 |
| D0270 |
|
37 |
36 |
$280.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$70.00 |
| D9996 |
|
53 |
48 |
$0.00 |