| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,522 |
1,439 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,482 |
1,377 |
$40K |
| D1120 |
Prophylaxis - child |
732 |
696 |
$29K |
| D1206 |
Topical application of fluoride varnish |
645 |
620 |
$21K |
| D0274 |
Bitewings - four radiographic images |
970 |
886 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
547 |
515 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,686 |
1,554 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
686 |
649 |
$14K |
| D1351 |
Sealant - per tooth |
447 |
48 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,567 |
1,207 |
$8K |
| D1110 |
Prophylaxis - adult |
376 |
343 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
114 |
43 |
$5K |
| D0272 |
Bitewings - two radiographic images |
31 |
30 |
$543.21 |
| D0160 |
|
13 |
13 |
$337.00 |