| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
98 |
62 |
$11K |
| D1110 |
Prophylaxis - adult |
196 |
187 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
73 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
583 |
565 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
87 |
$3K |
| D0274 |
Bitewings - four radiographic images |
40 |
39 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$559.20 |
| D0330 |
Panoramic radiographic image |
268 |
260 |
$285.25 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
16 |
$231.96 |
| D0272 |
Bitewings - two radiographic images |
238 |
231 |
$107.15 |
| D1120 |
Prophylaxis - child |
363 |
357 |
$70.04 |
| D1206 |
Topical application of fluoride varnish |
59 |
58 |
$48.58 |
| D1208 |
Topical application of fluoride, excluding varnish |
311 |
302 |
$19.77 |