| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
58 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
209 |
198 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
33 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
99 |
98 |
$2K |
| D0274 |
Bitewings - four radiographic images |
70 |
66 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
152 |
138 |
$2K |
| D1110 |
Prophylaxis - adult |
29 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
55 |
49 |
$953.18 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
28 |
$923.30 |