| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
732 |
701 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,494 |
1,452 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
467 |
206 |
$26K |
| D1110 |
Prophylaxis - adult |
701 |
663 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
581 |
553 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
784 |
772 |
$13K |
| D1120 |
Prophylaxis - child |
407 |
404 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
40 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| D2330 |
|
13 |
12 |
$656.73 |