| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
377 |
238 |
$24K |
| D0330 |
Panoramic radiographic image |
301 |
301 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
508 |
499 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
349 |
$5K |
| D1110 |
Prophylaxis - adult |
318 |
316 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
486 |
471 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
24 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
27 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
290 |
289 |
$1K |
| D0274 |
Bitewings - four radiographic images |
186 |
183 |
$934.76 |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
86 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
54 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
50 |
$0.00 |
| D1120 |
Prophylaxis - child |
44 |
44 |
$0.00 |