| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
298 |
$13K |
| D1120 |
Prophylaxis - child |
295 |
288 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
30 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
29 |
$6K |
| D1206 |
Topical application of fluoride varnish |
210 |
208 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
50 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$708.76 |
| D0274 |
Bitewings - four radiographic images |
26 |
25 |
$679.26 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
28 |
$509.10 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$256.44 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
16 |
$232.16 |