| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
410 |
405 |
$17K |
| D1110 |
Prophylaxis - adult |
549 |
544 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
329 |
230 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
243 |
239 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
82 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
168 |
$3K |
| D2331 |
|
22 |
17 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
948 |
931 |
$627.28 |
| D0330 |
Panoramic radiographic image |
344 |
340 |
$482.23 |
| D0220 |
Intraoral - periapical first radiographic image |
1,182 |
1,160 |
$175.15 |
| D0274 |
Bitewings - four radiographic images |
819 |
810 |
$159.05 |
| D1330 |
|
84 |
83 |
$0.00 |