| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
35 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
115 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
14 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
17 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$497.10 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
24 |
$303.50 |