| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
867 |
318 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
836 |
266 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
190 |
98 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
241 |
241 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
133 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
96 |
$1K |