| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,807 |
1,523 |
$361K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,075 |
1,489 |
$277K |
| D0120 |
Periodic oral evaluation - established patient |
6,350 |
6,285 |
$176K |
| D1110 |
Prophylaxis - adult |
3,279 |
3,231 |
$157K |
| D1120 |
Prophylaxis - child |
3,625 |
3,590 |
$127K |
| D0272 |
Bitewings - two radiographic images |
3,012 |
2,973 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,861 |
2,837 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
413 |
220 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
622 |
601 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,249 |
1,220 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
242 |
228 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
322 |
315 |
$5K |
| D0330 |
Panoramic radiographic image |
64 |
64 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
117 |
71 |
$869.40 |
| D0350 |
|
126 |
123 |
$0.00 |