| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
171 |
56 |
$22K |
| D0330 |
Panoramic radiographic image |
327 |
319 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
64 |
$11K |
| D9310 |
|
158 |
154 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
132 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
477 |
427 |
$6K |
| D9110 |
|
238 |
222 |
$5K |
| D1110 |
Prophylaxis - adult |
200 |
191 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
170 |
158 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
341 |
338 |
$3K |
| D4910 |
|
52 |
51 |
$968.64 |
| D0274 |
Bitewings - four radiographic images |
56 |
53 |
$466.44 |
| D0220 |
Intraoral - periapical first radiographic image |
138 |
126 |
$377.78 |