| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
671 |
382 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,567 |
1,566 |
$38K |
| D1120 |
Prophylaxis - child |
1,105 |
1,104 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,689 |
1,687 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
477 |
341 |
$28K |
| D1110 |
Prophylaxis - adult |
614 |
614 |
$26K |
| D0274 |
Bitewings - four radiographic images |
944 |
943 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,309 |
1,581 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,696 |
1,685 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
354 |
302 |
$10K |
| D0272 |
Bitewings - two radiographic images |
523 |
523 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
101 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
56 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$955.24 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$317.20 |