| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2950 |
|
204 |
111 |
$171.34 |
| D0140 |
Limited oral evaluation - problem focused |
373 |
272 |
$80.68 |
| D0220 |
Intraoral - periapical first radiographic image |
1,277 |
1,081 |
$63.19 |
| D0274 |
Bitewings - four radiographic images |
349 |
307 |
$39.99 |
| D0120 |
Periodic oral evaluation - established patient |
244 |
224 |
$37.61 |
| D1110 |
Prophylaxis - adult |
154 |
139 |
$28.54 |
| D0230 |
Intraoral - periapical each additional radiographic image |
829 |
717 |
$17.84 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
67 |
39 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
75 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
29 |
$0.00 |