| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
553 |
259 |
$3K |
| D1110 |
Prophylaxis - adult |
40 |
40 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
268 |
$1K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$609.96 |
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$451.92 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$366.30 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
38 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
25 |
$0.00 |