| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
390 |
375 |
$36K |
| D0274 |
Bitewings - four radiographic images |
488 |
460 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
257 |
247 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
213 |
$13K |
| D1110 |
Prophylaxis - adult |
166 |
155 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
445 |
429 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
44 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
246 |
231 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
36 |
$9K |
| D1120 |
Prophylaxis - child |
95 |
94 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
251 |
231 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$2K |
| D9211 |
|
30 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$529.36 |