| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
215 |
165 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
202 |
159 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
47 |
$3K |
| D0330 |
Panoramic radiographic image |
242 |
190 |
$3K |
| D1120 |
Prophylaxis - child |
43 |
40 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
52 |
$1K |
| D1206 |
Topical application of fluoride varnish |
41 |
39 |
$910.00 |
| D9310 |
|
29 |
13 |
$553.50 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
38 |
$406.00 |
| D4355 |
|
24 |
15 |
$280.00 |
| D9991 |
|
42 |
16 |
$71.75 |
| D9993 |
|
17 |
13 |
$10.25 |
| D9992 |
|
19 |
14 |
$0.00 |
| D9994 |
|
19 |
14 |
$0.00 |