| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
432 |
220 |
$8K |
| D1110 |
Prophylaxis - adult |
309 |
168 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
250 |
134 |
$5K |
| D0330 |
Panoramic radiographic image |
358 |
198 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
95 |
28 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
55 |
39 |
$867.58 |
| D0272 |
Bitewings - two radiographic images |
17 |
16 |
$89.25 |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
25 |
$86.82 |
| D0274 |
Bitewings - four radiographic images |
155 |
89 |
$68.00 |