| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
907 |
403 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
807 |
791 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
197 |
178 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
27 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
251 |
200 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
178 |
157 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
25 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
30 |
$0.00 |