| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
484 |
466 |
$19K |
| D1110 |
Prophylaxis - adult |
381 |
364 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
463 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
120 |
$12K |
| D0274 |
Bitewings - four radiographic images |
376 |
360 |
$9K |
| D9110 |
|
200 |
176 |
$7K |
| D1120 |
Prophylaxis - child |
69 |
67 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
45 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
193 |
186 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
282 |
267 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
132 |
84 |
$677.82 |
| D9986 |
|
204 |
185 |
$366.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$321.50 |
| D9987 |
|
82 |
73 |
$135.00 |