| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
200 |
189 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
28 |
$8K |
| D1110 |
Prophylaxis - adult |
152 |
145 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
72 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
257 |
245 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
167 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
380 |
366 |
$5K |
| D0274 |
Bitewings - four radiographic images |
157 |
150 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
193 |
187 |
$4K |
| D2950 |
|
15 |
12 |
$2K |