| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
814 |
687 |
$17K |
| D9310 |
|
353 |
313 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
78 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
144 |
70 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
288 |
223 |
$6K |
| D0274 |
Bitewings - four radiographic images |
324 |
259 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
524 |
439 |
$4K |
| D1110 |
Prophylaxis - adult |
191 |
152 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
367 |
251 |
$2K |
| D1206 |
Topical application of fluoride varnish |
109 |
89 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
35 |
$927.76 |
| D0120 |
Periodic oral evaluation - established patient |
41 |
34 |
$500.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$157.94 |
| D0270 |
|
19 |
17 |
$94.32 |