| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,225 |
1,155 |
$80K |
| D0274 |
Bitewings - four radiographic images |
589 |
584 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
737 |
733 |
$29K |
| D1110 |
Prophylaxis - adult |
614 |
607 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
728 |
715 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
54 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
52 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
131 |
130 |
$4K |
| D1120 |
Prophylaxis - child |
161 |
161 |
$4K |
| D0330 |
Panoramic radiographic image |
54 |
51 |
$2K |
| D1206 |
Topical application of fluoride varnish |
187 |
187 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
15 |
$0.00 |