| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
532 |
499 |
$19K |
| D0274 |
Bitewings - four radiographic images |
645 |
609 |
$13K |
| D1120 |
Prophylaxis - child |
259 |
224 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
490 |
461 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
243 |
217 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
39 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
178 |
170 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
284 |
266 |
$3K |
| D1110 |
Prophylaxis - adult |
214 |
142 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
119 |
106 |
$630.23 |
| D1208 |
Topical application of fluoride, excluding varnish |
32 |
30 |
$286.72 |