| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,069 |
560 |
$0.00 |
| D0603 |
|
22 |
15 |
$0.00 |
| D1330 |
|
483 |
438 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
377 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
392 |
358 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
719 |
588 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
183 |
160 |
$0.00 |
| D0601 |
|
526 |
442 |
$0.00 |
| D0602 |
|
335 |
273 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
560 |
193 |
$0.00 |
| D1320 |
|
14 |
12 |
$0.00 |
| D0170 |
|
65 |
45 |
$0.00 |
| D1351 |
Sealant - per tooth |
45 |
30 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D0270 |
|
417 |
340 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
529 |
446 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,243 |
1,025 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
28 |
$0.00 |
| D1120 |
Prophylaxis - child |
98 |
87 |
$0.00 |
| D1354 |
|
396 |
191 |
$0.00 |
| D1110 |
Prophylaxis - adult |
155 |
148 |
$0.00 |
| D0330 |
Panoramic radiographic image |
806 |
676 |
$0.00 |
| D0191 |
|
62 |
59 |
$0.00 |