| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,327 |
1,325 |
$35K |
| D1110 |
Prophylaxis - adult |
857 |
854 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
291 |
$26K |
| D0330 |
Panoramic radiographic image |
647 |
647 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
205 |
163 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
685 |
685 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,744 |
1,727 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
640 |
639 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,318 |
1,282 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
52 |
$3K |
| D1330 |
|
652 |
652 |
$3K |
| D9110 |
|
29 |
29 |
$833.40 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$259.22 |
| D9215 |
|
140 |
130 |
$0.00 |