| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
417 |
416 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
453 |
447 |
$15K |
| D1110 |
Prophylaxis - adult |
211 |
210 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
318 |
317 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
103 |
$8K |
| D0274 |
Bitewings - four radiographic images |
263 |
262 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
220 |
219 |
$2K |
| D9994 |
|
77 |
77 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
15 |
$1K |