| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
750 |
708 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
803 |
713 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
463 |
185 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
629 |
598 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
297 |
270 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
864 |
798 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,347 |
842 |
$10K |
| D0274 |
Bitewings - four radiographic images |
444 |
415 |
$10K |
| D1120 |
Prophylaxis - child |
146 |
145 |
$7K |
| D1206 |
Topical application of fluoride varnish |
160 |
158 |
$6K |
| D1110 |
Prophylaxis - adult |
244 |
228 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
111 |
95 |
$2K |
| D9310 |
|
14 |
14 |
$603.00 |
| D0270 |
|
12 |
12 |
$129.69 |