| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,454 |
3,274 |
$155K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,972 |
624 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,824 |
3,618 |
$105K |
| D1110 |
Prophylaxis - adult |
2,023 |
1,937 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,084 |
2,001 |
$48K |
| D1120 |
Prophylaxis - child |
381 |
374 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
365 |
123 |
$18K |
| D5110 |
|
29 |
28 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,000 |
963 |
$15K |
| D9110 |
|
498 |
466 |
$12K |
| D5120 |
|
13 |
12 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
158 |
$7K |
| D0272 |
Bitewings - two radiographic images |
90 |
69 |
$970.72 |
| D0120 |
Periodic oral evaluation - established patient |
28 |
28 |
$660.00 |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
47 |
$523.00 |