| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,316 |
629 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
2,728 |
2,631 |
$75K |
| D1110 |
Prophylaxis - adult |
1,465 |
1,402 |
$75K |
| D0145 |
Oral evaluation for a patient under three years of age |
535 |
523 |
$73K |
| D1120 |
Prophylaxis - child |
1,579 |
1,531 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,266 |
1,215 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,736 |
2,646 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,216 |
1,185 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
324 |
210 |
$24K |
| D0330 |
Panoramic radiographic image |
522 |
493 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
59 |
38 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
190 |
178 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
220 |
210 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
27 |
$892.55 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
25 |
$835.30 |
| D0603 |
|
3,263 |
3,170 |
$0.00 |
| D0602 |
|
101 |
98 |
$0.00 |