| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
292 |
276 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
192 |
179 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
217 |
$6K |
| D1110 |
Prophylaxis - adult |
98 |
92 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
292 |
$3K |
| D0274 |
Bitewings - four radiographic images |
85 |
82 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$990.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
83 |
54 |
$575.70 |