| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,181 |
2,177 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,372 |
793 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
1,575 |
1,566 |
$66K |
| D1110 |
Prophylaxis - adult |
771 |
771 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,256 |
1,255 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,015 |
1,014 |
$33K |
| D1120 |
Prophylaxis - child |
300 |
300 |
$18K |
| D1206 |
Topical application of fluoride varnish |
394 |
394 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
359 |
359 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
75 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
185 |
185 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
73 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
235 |
$3K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$540.75 |
| D1999 |
|
693 |
643 |
$0.00 |