| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
344 |
332 |
$1K |
| D1110 |
Prophylaxis - adult |
95 |
95 |
$670.11 |
| D0330 |
Panoramic radiographic image |
80 |
71 |
$490.35 |
| D0274 |
Bitewings - four radiographic images |
141 |
141 |
$438.48 |
| D0120 |
Periodic oral evaluation - established patient |
42 |
42 |
$298.25 |
| D0210 |
Intraoral - complete series of radiographic images |
296 |
202 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
110 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
70 |
69 |
$0.00 |
| D9630 |
|
156 |
154 |
$0.00 |
| D9994 |
|
69 |
68 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
64 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
226 |
217 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
136 |
66 |
$0.00 |
| D2950 |
|
14 |
13 |
$0.00 |