| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
445 |
437 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
427 |
222 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
787 |
774 |
$17K |
| D1110 |
Prophylaxis - adult |
815 |
800 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
663 |
645 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
358 |
332 |
$8K |
| D0274 |
Bitewings - four radiographic images |
511 |
497 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
481 |
469 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
400 |
391 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
81 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
149 |
$910.75 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |
| D4355 |
|
43 |
43 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
27 |
$0.00 |