| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
613 |
551 |
$13K |
| D0330 |
Panoramic radiographic image |
317 |
276 |
$12K |
| D7240 |
Removal of impacted tooth - completely bony |
38 |
12 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
30 |
$5K |
| D0274 |
Bitewings - four radiographic images |
263 |
242 |
$4K |
| D7230 |
|
26 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
208 |
184 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
638 |
493 |
$2K |
| D1110 |
Prophylaxis - adult |
69 |
64 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
481 |
392 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
62 |
51 |
$806.16 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$260.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$195.00 |