| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
670 |
395 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,404 |
1,297 |
$55K |
| D2740 |
Crown - porcelain/ceramic |
60 |
54 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
167 |
124 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
500 |
460 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
696 |
653 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
88 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
402 |
368 |
$5K |
| D2950 |
|
30 |
25 |
$4K |