| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
398 |
362 |
$13K |
| D0330 |
Panoramic radiographic image |
182 |
171 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
628 |
363 |
$7K |
| D1120 |
Prophylaxis - child |
179 |
170 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
106 |
$3K |
| D1206 |
Topical application of fluoride varnish |
105 |
102 |
$2K |
| D0274 |
Bitewings - four radiographic images |
76 |
72 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
26 |
24 |
$606.93 |
| D1999 |
|
108 |
105 |
$0.00 |
| D9630 |
|
57 |
56 |
$0.00 |