| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
440 |
438 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
177 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
72 |
$4K |
| D0274 |
Bitewings - four radiographic images |
138 |
137 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
287 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D4346 |
|
24 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$667.03 |
| D0270 |
|
44 |
43 |
$446.65 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$314.40 |