| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,820 |
1,763 |
$35K |
| D0330 |
Panoramic radiographic image |
673 |
641 |
$27K |
| D1110 |
Prophylaxis - adult |
532 |
521 |
$22K |
| D0274 |
Bitewings - four radiographic images |
965 |
946 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
222 |
147 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
563 |
550 |
$16K |
| D9630 |
|
663 |
640 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
581 |
564 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
28 |
$4K |
| D1206 |
Topical application of fluoride varnish |
181 |
179 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
210 |
202 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
38 |
$1K |
| D1120 |
Prophylaxis - child |
40 |
38 |
$905.04 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$273.13 |
| D4341 |
|
137 |
64 |
$0.00 |