| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,264 |
1,261 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,025 |
1,019 |
$1K |
| D0274 |
Bitewings - four radiographic images |
698 |
694 |
$658.00 |
| D0220 |
Intraoral - periapical first radiographic image |
479 |
461 |
$220.00 |
| D1999 |
|
705 |
647 |
$0.00 |
| D0330 |
Panoramic radiographic image |
800 |
798 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
108 |
83 |
$0.00 |
| D1120 |
Prophylaxis - child |
75 |
74 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
829 |
825 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
242 |
230 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
123 |
122 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
86 |
86 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
26 |
$0.00 |