| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,168 |
1,122 |
$45K |
| D1120 |
Prophylaxis - child |
675 |
639 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,210 |
1,149 |
$24K |
| D0274 |
Bitewings - four radiographic images |
977 |
919 |
$22K |
| D1206 |
Topical application of fluoride varnish |
661 |
628 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
437 |
402 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
121 |
31 |
$8K |
| D0272 |
Bitewings - two radiographic images |
291 |
282 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
325 |
$4K |
| D1351 |
Sealant - per tooth |
192 |
32 |
$4K |
| D9110 |
|
107 |
101 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
320 |
254 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
35 |
35 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
38 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
46 |
46 |
$800.00 |
| D9310 |
|
26 |
24 |
$760.00 |
| D0601 |
|
98 |
85 |
$405.50 |
| D1999 |
|
12 |
12 |
$180.00 |
| D9987 |
|
22 |
21 |
$0.00 |