| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
124 |
101 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
149 |
89 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
308 |
286 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
222 |
191 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
152 |
148 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
13 |
$179.12 |