| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
146 |
104 |
$1K |
| D0330 |
Panoramic radiographic image |
64 |
50 |
$881.40 |
| D1120 |
Prophylaxis - child |
37 |
28 |
$870.65 |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
33 |
$845.50 |
| D1110 |
Prophylaxis - adult |
63 |
47 |
$816.22 |
| D0274 |
Bitewings - four radiographic images |
86 |
60 |
$677.70 |
| D2330 |
|
29 |
16 |
$583.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
19 |
$550.32 |
| D1208 |
Topical application of fluoride, excluding varnish |
71 |
54 |
$501.01 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
20 |
$492.50 |
| D2331 |
|
18 |
12 |
$398.20 |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
82 |
$314.09 |