| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,066 |
1,058 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
567 |
563 |
$25K |
| D1120 |
Prophylaxis - child |
686 |
684 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
484 |
483 |
$19K |
| D9430 |
|
484 |
471 |
$15K |
| D1110 |
Prophylaxis - adult |
164 |
163 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
89 |
76 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,377 |
1,123 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
494 |
488 |
$7K |
| D0272 |
Bitewings - two radiographic images |
227 |
224 |
$3K |
| D1206 |
Topical application of fluoride varnish |
48 |
47 |
$636.00 |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
52 |
$624.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$259.20 |