| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,167 |
2,102 |
$82K |
| D0330 |
Panoramic radiographic image |
2,124 |
2,035 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,777 |
2,669 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,547 |
642 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
764 |
394 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
960 |
890 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,379 |
1,152 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,101 |
1,064 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,379 |
1,340 |
$22K |
| D1351 |
Sealant - per tooth |
1,006 |
168 |
$18K |
| D1120 |
Prophylaxis - child |
395 |
380 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,576 |
1,452 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
820 |
792 |
$12K |
| D2394 |
|
31 |
24 |
$2K |
| D7250 |
|
29 |
14 |
$2K |
| D2335 |
|
24 |
15 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$378.00 |
| D1206 |
Topical application of fluoride varnish |
26 |
23 |
$332.63 |
| D9986 |
|
894 |
760 |
$228.00 |