| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,010 |
1,004 |
$37K |
| D1110 |
Prophylaxis - adult |
563 |
560 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
149 |
72 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
780 |
776 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
99 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
324 |
324 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
228 |
227 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
14 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$561.14 |
| D0274 |
Bitewings - four radiographic images |
242 |
242 |
$532.28 |
| D1330 |
|
607 |
605 |
$292.76 |
| D0220 |
Intraoral - periapical first radiographic image |
385 |
384 |
$197.87 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$25.27 |
| D1206 |
Topical application of fluoride varnish |
79 |
79 |
$16.35 |