| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
573 |
549 |
$321.50 |
| D0140 |
Limited oral evaluation - problem focused |
448 |
413 |
$230.09 |
| D2950 |
|
227 |
131 |
$108.51 |
| D0220 |
Intraoral - periapical first radiographic image |
631 |
570 |
$80.45 |
| D0274 |
Bitewings - four radiographic images |
438 |
426 |
$52.58 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
87 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
86 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
132 |
128 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
101 |
67 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
14 |
$0.00 |