| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
225 |
$5K |
| D0330 |
Panoramic radiographic image |
90 |
89 |
$4K |
| D0274 |
Bitewings - four radiographic images |
132 |
132 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
105 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$655.52 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$565.12 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$290.24 |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
170 |
$247.44 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$201.31 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
14 |
$69.14 |
| D0272 |
Bitewings - two radiographic images |
17 |
16 |
$26.88 |
| 1036F |
|
13 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$0.00 |
| 2001F |
|
46 |
43 |
$0.00 |
| 2000F |
|
44 |
42 |
$0.00 |
| 3044F |
|
12 |
12 |
$0.00 |
| 1000F |
|
29 |
27 |
$0.00 |
| D1310 |
|
46 |
46 |
$0.00 |
| D1330 |
|
46 |
46 |
$0.00 |
| 4136F |
|
12 |
12 |
$0.00 |
| 3008F |
|
47 |
44 |
$0.00 |
| 2010F |
|
45 |
43 |
$0.00 |