| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
154 |
154 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
248 |
227 |
$9K |
| D2950 |
|
52 |
26 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
35 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
388 |
338 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
123 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
14 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
238 |
141 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$407.37 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$336.82 |