| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,780 |
1,724 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,039 |
1,980 |
$69K |
| D1110 |
Prophylaxis - adult |
1,303 |
1,274 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,691 |
1,644 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,102 |
1,061 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
171 |
67 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
449 |
435 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
275 |
271 |
$7K |
| D1120 |
Prophylaxis - child |
95 |
89 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
25 |
$3K |
| D2394 |
|
43 |
37 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
190 |
185 |
$1K |
| D0431 |
|
13 |
13 |
$130.00 |