| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
445 |
442 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
349 |
342 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
41 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
558 |
540 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
115 |
$5K |
| D1110 |
Prophylaxis - adult |
89 |
89 |
$5K |
| D0460 |
|
149 |
145 |
$4K |
| D0274 |
Bitewings - four radiographic images |
122 |
122 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
15 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
73 |
73 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$46.19 |