| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,263 |
1,154 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,267 |
139 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
978 |
885 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
373 |
51 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
621 |
573 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,574 |
1,394 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,766 |
783 |
$19K |
| D0274 |
Bitewings - four radiographic images |
672 |
605 |
$18K |
| D1110 |
Prophylaxis - adult |
123 |
116 |
$6K |
| D4910 |
|
56 |
53 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
40 |
37 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$1K |
| D1999 |
|
12 |
12 |
$0.00 |