| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,288 |
1,287 |
$2K |
| D1110 |
Prophylaxis - adult |
1,517 |
1,511 |
$2K |
| D0274 |
Bitewings - four radiographic images |
1,430 |
1,424 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,525 |
2,486 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,199 |
2,085 |
$1K |
| D0330 |
Panoramic radiographic image |
799 |
794 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
1,754 |
1,750 |
$546.00 |
| D1120 |
Prophylaxis - child |
215 |
214 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
216 |
167 |
$0.00 |
| D1999 |
|
821 |
727 |
$0.00 |
| D2999 |
|
16 |
15 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
376 |
373 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
408 |
396 |
$0.00 |
| D9310 |
|
128 |
126 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$0.00 |