| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
426 |
389 |
$7K |
| D0330 |
Panoramic radiographic image |
309 |
253 |
$6K |
| D1120 |
Prophylaxis - child |
211 |
189 |
$6K |
| D1110 |
Prophylaxis - adult |
148 |
125 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
258 |
225 |
$5K |
| D1206 |
Topical application of fluoride varnish |
105 |
91 |
$2K |
| D0274 |
Bitewings - four radiographic images |
216 |
206 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
58 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
430 |
408 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
158 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
386 |
272 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
15 |
$802.10 |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
51 |
$348.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
19 |
$320.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
72 |
71 |
$152.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$60.00 |
| D1330 |
|
72 |
72 |
$10.00 |
| D1310 |
|
20 |
20 |
$10.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| D9986 |
|
137 |
131 |
$0.00 |