| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,330 |
1,243 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
358 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
134 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
261 |
256 |
$25K |
| D0274 |
Bitewings - four radiographic images |
619 |
610 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,912 |
757 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
157 |
43 |
$7K |
| D0270 |
|
25 |
25 |
$6K |
| D1206 |
Topical application of fluoride varnish |
314 |
312 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
20 |
$2K |
| D1110 |
Prophylaxis - adult |
138 |
135 |
$2K |
| D0330 |
Panoramic radiographic image |
96 |
95 |
$139.17 |
| D1120 |
Prophylaxis - child |
64 |
63 |
$56.67 |
| D9211 |
|
107 |
65 |
$0.00 |
| D2950 |
|
13 |
12 |
$0.00 |