| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,262 |
2,949 |
$829K |
| D0120 |
Periodic oral evaluation - established patient |
7,390 |
7,324 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,896 |
7,024 |
$209K |
| D1110 |
Prophylaxis - adult |
3,408 |
3,374 |
$183K |
| D1120 |
Prophylaxis - child |
4,634 |
4,585 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,953 |
905 |
$153K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,662 |
8,573 |
$125K |
| D0272 |
Bitewings - two radiographic images |
4,452 |
4,416 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
7,444 |
7,335 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
711 |
708 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,265 |
1,254 |
$43K |
| D0145 |
Oral evaluation for a patient under three years of age |
248 |
245 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
353 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
270 |
261 |
$7K |
| D2335 |
|
27 |
12 |
$4K |
| D2330 |
|
19 |
12 |
$1K |
| D0240 |
|
59 |
33 |
$463.73 |
| D0340 |
|
13 |
13 |
$297.72 |
| D0160 |
|
12 |
12 |
$104.65 |
| D0603 |
|
9,964 |
9,799 |
$0.00 |