| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,149 |
935 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,043 |
919 |
$39K |
| D1110 |
Prophylaxis - adult |
667 |
559 |
$26K |
| D0272 |
Bitewings - two radiographic images |
497 |
438 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
67 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
239 |
216 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
267 |
229 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
71 |
44 |
$539.79 |