| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
502 |
449 |
$16K |
| D1110 |
Prophylaxis - adult |
438 |
405 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
519 |
442 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
573 |
504 |
$13K |
| D1120 |
Prophylaxis - child |
208 |
180 |
$8K |
| D0274 |
Bitewings - four radiographic images |
317 |
279 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
667 |
575 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
255 |
231 |
$4K |
| D0272 |
Bitewings - two radiographic images |
256 |
218 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
43 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
186 |
165 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
41 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$593.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$63.21 |
| D9986 |
|
37 |
28 |
$0.00 |