| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
457 |
449 |
$783.61 |
| D0140 |
Limited oral evaluation - problem focused |
602 |
585 |
$630.48 |
| D0274 |
Bitewings - four radiographic images |
1,118 |
1,091 |
$606.25 |
| D0220 |
Intraoral - periapical first radiographic image |
1,712 |
1,551 |
$549.66 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,832 |
1,325 |
$507.42 |
| D1120 |
Prophylaxis - child |
345 |
342 |
$274.32 |
| D0120 |
Periodic oral evaluation - established patient |
695 |
690 |
$238.92 |
| D1110 |
Prophylaxis - adult |
404 |
402 |
$234.33 |
| D1208 |
Topical application of fluoride, excluding varnish |
703 |
696 |
$163.91 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
110 |
$89.16 |
| D0272 |
Bitewings - two radiographic images |
27 |
25 |
$51.45 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
12 |
$0.00 |