| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
277 |
$6K |
| D1110 |
Prophylaxis - adult |
223 |
218 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
292 |
280 |
$6K |
| D0274 |
Bitewings - four radiographic images |
344 |
338 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
719 |
685 |
$4K |
| D0330 |
Panoramic radiographic image |
86 |
84 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
328 |
308 |
$1K |