| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
94 |
55 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
246 |
$5K |
| D0330 |
Panoramic radiographic image |
100 |
99 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
41 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
109 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
28 |
$1K |
| D1110 |
Prophylaxis - adult |
28 |
25 |
$847.25 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
26 |
$120.00 |