| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
387 |
371 |
$1K |
| D1206 |
Topical application of fluoride varnish |
712 |
680 |
$528.45 |
| D0210 |
Intraoral - complete series of radiographic images |
621 |
602 |
$90.74 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
751 |
726 |
$54.66 |
| D0330 |
Panoramic radiographic image |
173 |
168 |
$34.03 |
| D0140 |
Limited oral evaluation - problem focused |
753 |
723 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,631 |
628 |
$0.00 |
| D1330 |
|
113 |
109 |
$0.00 |
| D9215 |
|
24 |
18 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
27 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
121 |
116 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
671 |
643 |
$0.00 |
| D0270 |
|
247 |
233 |
$0.00 |
| D4341 |
|
25 |
14 |
$0.00 |
| D0191 |
|
13 |
13 |
$0.00 |