| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
312 |
309 |
$20K |
| D1110 |
Prophylaxis - adult |
232 |
228 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
363 |
358 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
31 |
$6K |
| D0272 |
Bitewings - two radiographic images |
190 |
190 |
$4K |
| D9994 |
|
151 |
151 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
331 |
291 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
41 |
$3K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$2K |
| D1206 |
Topical application of fluoride varnish |
124 |
124 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
69 |
67 |
$2K |
| D0274 |
Bitewings - four radiographic images |
18 |
17 |
$540.76 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
14 |
$198.00 |