| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
639 |
619 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
940 |
918 |
$42K |
| D1110 |
Prophylaxis - adult |
581 |
563 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,050 |
1,014 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
434 |
$25K |
| D0274 |
Bitewings - four radiographic images |
519 |
503 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
602 |
579 |
$20K |
| D1120 |
Prophylaxis - child |
546 |
530 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
121 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
654 |
638 |
$12K |
| D0272 |
Bitewings - two radiographic images |
409 |
404 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
142 |
137 |
$2K |