| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
709 |
669 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
295 |
106 |
$77K |
| D0274 |
Bitewings - four radiographic images |
509 |
478 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
566 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
474 |
454 |
$42K |
| D2950 |
|
108 |
58 |
$33K |
| D2752 |
|
32 |
14 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
175 |
59 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
26 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
105 |
93 |
$3K |
| D0350 |
|
82 |
82 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$1K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$1K |