| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,757 |
750 |
$178K |
| D1110 |
Prophylaxis - adult |
2,011 |
1,858 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,365 |
1,218 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,954 |
1,792 |
$47K |
| D0330 |
Panoramic radiographic image |
871 |
793 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,303 |
1,204 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,919 |
1,727 |
$29K |
| D1120 |
Prophylaxis - child |
1,009 |
951 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
196 |
110 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
541 |
490 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
412 |
283 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
85 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
653 |
576 |
$9K |
| D0272 |
Bitewings - two radiographic images |
370 |
333 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
138 |
127 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
14 |
$353.44 |
| D1999 |
|
14 |
14 |
$0.00 |