| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
605 |
603 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
681 |
679 |
$30K |
| D1110 |
Prophylaxis - adult |
488 |
484 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
116 |
$23K |
| D4341 |
|
152 |
56 |
$23K |
| D0274 |
Bitewings - four radiographic images |
731 |
726 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,022 |
1,003 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
20 |
14 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
238 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
333 |
332 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
904 |
835 |
$8K |
| D1206 |
Topical application of fluoride varnish |
252 |
252 |
$6K |
| D4910 |
|
26 |
26 |
$2K |
| D2950 |
|
16 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$1K |
| D4346 |
|
13 |
13 |
$933.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$253.25 |