| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
551 |
536 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
323 |
209 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
628 |
609 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
498 |
491 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
611 |
591 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
154 |
$19K |
| D0274 |
Bitewings - four radiographic images |
444 |
436 |
$18K |
| D0272 |
Bitewings - two radiographic images |
464 |
453 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
543 |
531 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
224 |
197 |
$4K |