| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
266 |
$9K |
| D0274 |
Bitewings - four radiographic images |
246 |
244 |
$7K |
| D1110 |
Prophylaxis - adult |
143 |
143 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
501 |
478 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
29 |
$4K |
| D0330 |
Panoramic radiographic image |
72 |
72 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
188 |
188 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
330 |
319 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
81 |
$2K |
| D2394 |
|
22 |
14 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
14 |
$2K |
| D9110 |
|
17 |
14 |
$909.50 |