| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,497 |
2,547 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,023 |
305 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,469 |
2,226 |
$22K |
| D0330 |
Panoramic radiographic image |
480 |
253 |
$12K |
| D1110 |
Prophylaxis - adult |
283 |
242 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
328 |
$10K |
| D0272 |
Bitewings - two radiographic images |
509 |
402 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
43 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
519 |
322 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
133 |
127 |
$2K |
| D7250 |
|
75 |
19 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
20 |
$597.30 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$402.24 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$396.56 |
| D1208 |
Topical application of fluoride, excluding varnish |
19 |
19 |
$395.01 |