| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
252 |
252 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
65 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
59 |
$4K |
| D0274 |
Bitewings - four radiographic images |
115 |
114 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
84 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
213 |
$2K |
| D1110 |
Prophylaxis - adult |
52 |
52 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
127 |
116 |
$1K |