| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
193 |
81 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
326 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
203 |
$6K |
| D1110 |
Prophylaxis - adult |
186 |
184 |
$5K |
| D0274 |
Bitewings - four radiographic images |
278 |
277 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
65 |
65 |
$0.00 |
| D4341 |
|
41 |
12 |
$0.00 |