| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
774 |
772 |
$31K |
| D1110 |
Prophylaxis - adult |
635 |
633 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
567 |
564 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
228 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
589 |
$6K |
| D1206 |
Topical application of fluoride varnish |
760 |
758 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
272 |
269 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
46 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,118 |
1,113 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,435 |
1,409 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,232 |
1,164 |
$834.74 |
| D0270 |
|
34 |
34 |
$143.24 |
| D1330 |
|
293 |
293 |
$7.00 |
| D1310 |
|
779 |
777 |
$0.00 |