| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
365 |
96 |
$46K |
| D0330 |
Panoramic radiographic image |
665 |
580 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
128 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
593 |
529 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
95 |
$22K |
| D0274 |
Bitewings - four radiographic images |
518 |
457 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
234 |
97 |
$20K |
| D4910 |
|
97 |
88 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
127 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
333 |
268 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
253 |
131 |
$4K |