| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
698 |
627 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
368 |
186 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
811 |
570 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,777 |
1,369 |
$27K |
| D1110 |
Prophylaxis - adult |
346 |
326 |
$16K |
| D0274 |
Bitewings - four radiographic images |
426 |
375 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
320 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,352 |
745 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
431 |
383 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
63 |
$9K |
| D5110 |
|
21 |
12 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
317 |
246 |
$6K |
| D0350 |
|
98 |
71 |
$1K |
| D1120 |
Prophylaxis - child |
25 |
24 |
$862.00 |