| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,009 |
702 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
2,966 |
2,812 |
$53K |
| D1110 |
Prophylaxis - adult |
1,417 |
1,348 |
$49K |
| D1120 |
Prophylaxis - child |
1,883 |
1,771 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,405 |
3,211 |
$47K |
| D0330 |
Panoramic radiographic image |
772 |
733 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,637 |
1,385 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,100 |
1,017 |
$18K |
| D0274 |
Bitewings - four radiographic images |
754 |
703 |
$16K |
| D2394 |
|
119 |
52 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
897 |
825 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
558 |
484 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
110 |
110 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$395.85 |