| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,762 |
1,761 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,617 |
1,613 |
$47K |
| D1110 |
Prophylaxis - adult |
748 |
746 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,164 |
1,160 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,218 |
1,200 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
65 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
371 |
364 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
492 |
490 |
$4K |
| D1120 |
Prophylaxis - child |
125 |
125 |
$4K |
| D0330 |
Panoramic radiographic image |
70 |
70 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$274.46 |