| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
316 |
308 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
330 |
322 |
$10K |
| D1110 |
Prophylaxis - adult |
284 |
278 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
383 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
101 |
$7K |
| D0274 |
Bitewings - four radiographic images |
283 |
277 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
380 |
364 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
28 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
68 |
67 |
$1K |
| D1120 |
Prophylaxis - child |
14 |
13 |
$360.75 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
24 |
$340.05 |
| D0230 |
Intraoral - periapical each additional radiographic image |
102 |
57 |
$302.13 |
| D9986 |
|
38 |
38 |
$0.00 |