| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,443 |
1,001 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,028 |
686 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
52 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
127 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
230 |
142 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
29 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
191 |
112 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
15 |
$740.00 |