| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
394 |
377 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
655 |
622 |
$22K |
| D1110 |
Prophylaxis - adult |
409 |
395 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
75 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
90 |
$11K |
| D5110 |
|
18 |
14 |
$10K |
| D0274 |
Bitewings - four radiographic images |
223 |
215 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
200 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
218 |
211 |
$6K |
| D1120 |
Prophylaxis - child |
87 |
86 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
95 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
37 |
$836.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
25 |
$660.00 |