| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
321 |
318 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
226 |
221 |
$0.00 |
| D1110 |
Prophylaxis - adult |
222 |
218 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
188 |
177 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
57 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
510 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
381 |
358 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
103 |
101 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
211 |
201 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
109 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
76 |
76 |
$0.00 |