| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
769 |
766 |
$50K |
| D0330 |
Panoramic radiographic image |
454 |
453 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
151 |
151 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
421 |
85 |
$2K |
| D9430 |
|
50 |
47 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$815.00 |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$360.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$259.20 |
| D0350 |
|
20 |
13 |
$163.20 |