| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
345 |
345 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
267 |
267 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
44 |
$7K |
| D1110 |
Prophylaxis - adult |
143 |
143 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
149 |
$4K |
| D0274 |
Bitewings - four radiographic images |
119 |
119 |
$4K |
| D1120 |
Prophylaxis - child |
76 |
76 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
142 |
142 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
100 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
40 |
40 |
$823.38 |