| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,055 |
1,021 |
$0.00 |
| D1354 |
|
13,155 |
687 |
$0.00 |
| D1110 |
Prophylaxis - adult |
439 |
416 |
$0.00 |
| D1321 |
|
721 |
657 |
$0.00 |
| D0191 |
|
212 |
196 |
$0.00 |
| D9996 |
|
243 |
237 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
33 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
26 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
28 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
18 |
17 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
679 |
658 |
$0.00 |
| D1330 |
|
1,871 |
1,716 |
$0.00 |
| D1310 |
|
1,143 |
1,059 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
707 |
672 |
$0.00 |
| D9995 |
|
450 |
442 |
$0.00 |
| D1355 |
|
22,947 |
974 |
$0.00 |
| D0603 |
|
1,087 |
1,011 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
559 |
540 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
967 |
912 |
$0.00 |
| D1320 |
|
564 |
512 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
22 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
20 |
19 |
$0.00 |