| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
712 |
688 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
332 |
194 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,931 |
1,882 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
614 |
394 |
$19K |
| D4341 |
|
848 |
291 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
460 |
450 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
190 |
116 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
82 |
53 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,024 |
1,112 |
$3K |
| D0274 |
Bitewings - four radiographic images |
464 |
449 |
$2K |
| D1110 |
Prophylaxis - adult |
79 |
77 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,482 |
2,229 |
$2K |
| D2332 |
|
29 |
12 |
$682.00 |
| D0120 |
Periodic oral evaluation - established patient |
16 |
16 |
$268.09 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$147.11 |
| D1206 |
Topical application of fluoride varnish |
34 |
33 |
$10.95 |
| D1330 |
|
44 |
43 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$0.00 |