| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
198 |
197 |
$15K |
| D0274 |
Bitewings - four radiographic images |
320 |
320 |
$14K |
| D1110 |
Prophylaxis - adult |
205 |
205 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
303 |
303 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
211 |
209 |
$10K |
| D1206 |
Topical application of fluoride varnish |
384 |
384 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
91 |
$10K |
| D1120 |
Prophylaxis - child |
239 |
239 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
396 |
386 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
122 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
59 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
211 |
182 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
28 |
$6K |
| D0272 |
Bitewings - two radiographic images |
102 |
102 |
$3K |