| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,037 |
1,017 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
213 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
300 |
197 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
221 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
74 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
148 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$960.00 |
| D0220 |
Intraoral - periapical first radiographic image |
138 |
136 |
$610.00 |
| D0270 |
|
12 |
12 |
$50.00 |