| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
344 |
142 |
$50K |
| D1110 |
Prophylaxis - adult |
454 |
437 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
718 |
651 |
$23K |
| D0274 |
Bitewings - four radiographic images |
589 |
573 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
50 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
408 |
391 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,940 |
1,055 |
$15K |
| D1320 |
|
609 |
581 |
$14K |
| D1321 |
|
599 |
569 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,390 |
1,275 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
283 |
274 |
$8K |
| D0330 |
Panoramic radiographic image |
106 |
102 |
$6K |
| D1120 |
Prophylaxis - child |
34 |
31 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$412.72 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$353.76 |
| D0350 |
|
17 |
13 |
$282.24 |