| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
3,022 |
578 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
280 |
191 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
420 |
417 |
$15K |
| D0274 |
Bitewings - four radiographic images |
519 |
514 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
229 |
158 |
$13K |
| D0330 |
Panoramic radiographic image |
277 |
271 |
$11K |
| D1110 |
Prophylaxis - adult |
222 |
219 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
223 |
222 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
522 |
510 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
282 |
280 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
142 |
140 |
$4K |
| D2331 |
|
22 |
12 |
$1K |
| D0603 |
|
28 |
28 |
$297.00 |