| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
784 |
720 |
$32K |
| D0330 |
Panoramic radiographic image |
623 |
575 |
$23K |
| D1110 |
Prophylaxis - adult |
466 |
447 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,022 |
954 |
$15K |
| D0274 |
Bitewings - four radiographic images |
586 |
548 |
$14K |
| D1120 |
Prophylaxis - child |
576 |
540 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
548 |
513 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
899 |
843 |
$10K |
| D1206 |
Topical application of fluoride varnish |
578 |
547 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
132 |
119 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
17 |
16 |
$309.60 |