| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,048 |
546 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
1,211 |
1,138 |
$1K |
| D0274 |
Bitewings - four radiographic images |
880 |
862 |
$831.30 |
| D1110 |
Prophylaxis - adult |
254 |
251 |
$701.08 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
684 |
674 |
$683.94 |
| D0220 |
Intraoral - periapical first radiographic image |
1,579 |
1,505 |
$648.40 |
| D0120 |
Periodic oral evaluation - established patient |
489 |
467 |
$486.48 |
| D0330 |
Panoramic radiographic image |
523 |
514 |
$290.21 |
| D4355 |
|
179 |
177 |
$205.71 |
| D0270 |
|
579 |
556 |
$191.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
536 |
510 |
$162.60 |
| D0210 |
Intraoral - complete series of radiographic images |
171 |
167 |
$160.83 |
| D1206 |
Topical application of fluoride varnish |
107 |
107 |
$141.61 |
| D2331 |
|
13 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
30 |
30 |
$0.00 |
| D9430 |
|
33 |
33 |
$0.00 |
| D4910 |
|
15 |
15 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
24 |
$0.00 |