| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
26 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
156 |
156 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
32 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$0.00 |
| D1110 |
Prophylaxis - adult |
89 |
88 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
60 |
60 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
76 |
74 |
$0.00 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$0.00 |