| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
924 |
391 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,098 |
1,049 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
41 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
258 |
258 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
212 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$303.66 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |