| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
300 |
290 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
128 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
354 |
342 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
195 |
125 |
$7K |
| D1110 |
Prophylaxis - adult |
178 |
171 |
$6K |
| D1120 |
Prophylaxis - child |
123 |
119 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
41 |
$4K |
| D0274 |
Bitewings - four radiographic images |
213 |
207 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
504 |
486 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
84 |
$2K |
| D0272 |
Bitewings - two radiographic images |
143 |
138 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
553 |
351 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
136 |
130 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
76 |
72 |
$1K |
| D0603 |
|
35 |
35 |
$0.00 |