| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
163 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$844.59 |
| D0140 |
Limited oral evaluation - problem focused |
147 |
139 |
$839.28 |
| D0220 |
Intraoral - periapical first radiographic image |
225 |
216 |
$813.68 |
| D2950 |
|
106 |
57 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
35 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$0.00 |