| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
814 |
413 |
$41K |
| D1120 |
Prophylaxis - child |
850 |
796 |
$33K |
| D1110 |
Prophylaxis - adult |
805 |
756 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
462 |
246 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,123 |
1,064 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
727 |
679 |
$16K |
| D0274 |
Bitewings - four radiographic images |
722 |
669 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,149 |
1,074 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
266 |
250 |
$13K |
| D0330 |
Panoramic radiographic image |
288 |
264 |
$8K |
| D2394 |
|
76 |
41 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
292 |
269 |
$2K |
| D2335 |
|
25 |
12 |
$2K |
| D2332 |
|
20 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
26 |
$663.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$425.70 |
| D0272 |
Bitewings - two radiographic images |
15 |
12 |
$202.02 |
| D1999 |
|
399 |
304 |
$0.00 |