| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,138 |
1,075 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
883 |
840 |
$34K |
| D0274 |
Bitewings - four radiographic images |
691 |
657 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,280 |
1,192 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
237 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
946 |
832 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
520 |
493 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
244 |
224 |
$8K |
| D1120 |
Prophylaxis - child |
158 |
149 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
38 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
178 |
169 |
$5K |
| D0330 |
Panoramic radiographic image |
38 |
37 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
74 |
68 |
$910.00 |
| D1330 |
|
177 |
176 |
$0.00 |