| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
552 |
403 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
499 |
267 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
712 |
601 |
$22K |
| D1120 |
Prophylaxis - child |
280 |
246 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
176 |
$6K |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$591.53 |
| D1351 |
Sealant - per tooth |
19 |
13 |
$560.70 |
| D1208 |
Topical application of fluoride, excluding varnish |
252 |
219 |
$328.88 |
| D0272 |
Bitewings - two radiographic images |
156 |
145 |
$220.33 |