| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
997 |
965 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,228 |
1,200 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
326 |
149 |
$33K |
| D1110 |
Prophylaxis - adult |
435 |
432 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
147 |
94 |
$14K |
| D0274 |
Bitewings - four radiographic images |
540 |
524 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
287 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
818 |
765 |
$6K |
| D1120 |
Prophylaxis - child |
172 |
171 |
$6K |
| D1206 |
Topical application of fluoride varnish |
163 |
162 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
571 |
548 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
175 |
174 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
79 |
78 |
$3K |
| D2950 |
|
13 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$463.00 |