| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
184 |
68 |
$9K |
| D0330 |
Panoramic radiographic image |
153 |
144 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
154 |
$2K |
| D0274 |
Bitewings - four radiographic images |
122 |
121 |
$764.37 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$401.75 |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
46 |
$173.74 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
43 |
$124.33 |
| D1330 |
|
12 |
12 |
$25.99 |
| D0350 |
|
63 |
62 |
$10.45 |