| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
81 |
81 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
117 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
31 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
17 |
$677.16 |
| D0120 |
Periodic oral evaluation - established patient |
39 |
36 |
$671.00 |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
64 |
$477.61 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$0.00 |