| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
113 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
67 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
184 |
184 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
45 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
77 |
$3K |
| D0160 |
|
15 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
48 |
$583.10 |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$535.59 |