| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,020 |
503 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,586 |
2,536 |
$65K |
| D1120 |
Prophylaxis - child |
1,151 |
1,125 |
$30K |
| D1110 |
Prophylaxis - adult |
692 |
684 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
313 |
192 |
$23K |
| D0274 |
Bitewings - four radiographic images |
681 |
671 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
486 |
437 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,107 |
1,088 |
$18K |
| D0330 |
Panoramic radiographic image |
312 |
309 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
389 |
382 |
$16K |
| D1206 |
Topical application of fluoride varnish |
548 |
538 |
$8K |
| D0272 |
Bitewings - two radiographic images |
374 |
372 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
122 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
58 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
40 |
$630.45 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$395.28 |
| D1999 |
|
236 |
222 |
$0.00 |