| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
414 |
399 |
$18K |
| D1110 |
Prophylaxis - adult |
519 |
507 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
487 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
70 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
488 |
475 |
$8K |
| D1120 |
Prophylaxis - child |
384 |
376 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
484 |
470 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
30 |
$3K |
| D0274 |
Bitewings - four radiographic images |
113 |
112 |
$2K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$250.00 |