| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,055 |
903 |
$31K |
| D0330 |
Panoramic radiographic image |
596 |
547 |
$22K |
| D1120 |
Prophylaxis - child |
399 |
353 |
$16K |
| D1206 |
Topical application of fluoride varnish |
410 |
365 |
$13K |
| D9110 |
|
534 |
346 |
$11K |
| D0272 |
Bitewings - two radiographic images |
553 |
511 |
$9K |
| D1351 |
Sealant - per tooth |
519 |
77 |
$8K |
| D0274 |
Bitewings - four radiographic images |
201 |
186 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
348 |
317 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
185 |
26 |
$3K |
| D4355 |
|
142 |
48 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
80 |
71 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
251 |
220 |
$1K |
| D0601 |
|
134 |
123 |
$600.00 |
| D9310 |
|
74 |
42 |
$400.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
13 |
$365.64 |
| D3120 |
|
369 |
13 |
$144.00 |