| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
727 |
711 |
$39K |
| D1110 |
Prophylaxis - adult |
539 |
530 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
631 |
615 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
612 |
605 |
$19K |
| D0274 |
Bitewings - four radiographic images |
340 |
334 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
39 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
493 |
478 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
71 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
507 |
274 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
105 |
104 |
$3K |
| D2394 |
|
26 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
177 |
173 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
14 |
$2K |