| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
93 |
52 |
$49K |
| D1110 |
Prophylaxis - adult |
272 |
266 |
$16K |
| D2950 |
|
163 |
96 |
$15K |
| D0330 |
Panoramic radiographic image |
218 |
213 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
307 |
303 |
$9K |
| D0274 |
Bitewings - four radiographic images |
279 |
272 |
$8K |
| D0431 |
|
227 |
217 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
216 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
61 |
59 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
214 |
101 |
$785.50 |
| D9986 |
|
148 |
140 |
$417.00 |
| D9987 |
|
92 |
84 |
$258.00 |