| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
491 |
411 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
867 |
777 |
$17K |
| D1110 |
Prophylaxis - adult |
512 |
506 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
161 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
464 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
375 |
268 |
$8K |
| D0274 |
Bitewings - four radiographic images |
506 |
493 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
136 |
77 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
315 |
310 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
371 |
360 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
82 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
104 |
102 |
$610.26 |
| D9630 |
|
26 |
26 |
$568.26 |
| D2740 |
Crown - porcelain/ceramic |
82 |
44 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
14 |
$0.00 |