| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
340 |
332 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
286 |
273 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
25 |
$8K |
| D0274 |
Bitewings - four radiographic images |
240 |
232 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
409 |
390 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
26 |
$5K |
| D1206 |
Topical application of fluoride varnish |
241 |
227 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
13 |
$4K |
| D1110 |
Prophylaxis - adult |
76 |
73 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
399 |
311 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
69 |
$2K |
| D1320 |
|
17 |
17 |
$621.03 |
| D0120 |
Periodic oral evaluation - established patient |
29 |
29 |
$574.60 |