| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
664 |
661 |
$26K |
| D1110 |
Prophylaxis - adult |
567 |
566 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
696 |
693 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
229 |
202 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
286 |
207 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
513 |
512 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
333 |
325 |
$3K |
| D1206 |
Topical application of fluoride varnish |
680 |
679 |
$2K |
| D0272 |
Bitewings - two radiographic images |
951 |
947 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,613 |
1,591 |
$1K |
| D0274 |
Bitewings - four radiographic images |
146 |
146 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
28 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,375 |
1,287 |
$794.48 |
| D0270 |
|
94 |
94 |
$247.54 |
| D1330 |
|
267 |
266 |
$1.00 |
| D9986 |
|
29 |
28 |
$0.00 |
| D1310 |
|
691 |
690 |
$0.00 |