| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
401 |
398 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
298 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
184 |
$9K |
| D0272 |
Bitewings - two radiographic images |
236 |
231 |
$4K |
| D1110 |
Prophylaxis - adult |
75 |
73 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
294 |
290 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
13 |
$935.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
38 |
$612.00 |