| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,194 |
2,153 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,561 |
999 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
454 |
339 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,720 |
920 |
$31K |
| D1110 |
Prophylaxis - adult |
1,012 |
991 |
$14K |
| D2332 |
|
246 |
164 |
$13K |
| D4341 |
|
464 |
152 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,175 |
2,137 |
$6K |
| D2331 |
|
102 |
71 |
$3K |
| D2330 |
|
123 |
74 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
280 |
280 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
65 |
65 |
$528.83 |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
299 |
$56.02 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$55.26 |