| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
420 |
294 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,267 |
1,255 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
206 |
$15K |
| D2931 |
|
57 |
51 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
224 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
41 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
25 |
$2K |
| D2330 |
|
20 |
12 |
$819.36 |
| D0140 |
Limited oral evaluation - problem focused |
42 |
41 |
$745.14 |