| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
485 |
459 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
436 |
387 |
$12K |
| D1110 |
Prophylaxis - adult |
281 |
265 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
362 |
335 |
$8K |
| D0274 |
Bitewings - four radiographic images |
362 |
343 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
52 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
246 |
236 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
29 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
546 |
495 |
$3K |
| D1120 |
Prophylaxis - child |
73 |
66 |
$3K |
| D2394 |
|
31 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
128 |
116 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
173 |
80 |
$473.79 |
| D1999 |
|
29 |
26 |
$0.00 |