| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
2,385 |
2,309 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,596 |
1,541 |
$51K |
| D0330 |
Panoramic radiographic image |
925 |
900 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,082 |
2,012 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
649 |
641 |
$20K |
| D1120 |
Prophylaxis - child |
429 |
423 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,882 |
2,619 |
$19K |
| D1351 |
Sealant - per tooth |
697 |
125 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
170 |
81 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,006 |
990 |
$10K |
| D1110 |
Prophylaxis - adult |
166 |
154 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
151 |
146 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
12 |
$955.27 |
| D0999 |
Unspecified diagnostic procedure, by report |
26 |
26 |
$780.00 |
| D0350 |
|
12 |
12 |
$184.50 |