| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
952 |
289 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,159 |
3,077 |
$85K |
| D1120 |
Prophylaxis - child |
2,380 |
2,324 |
$82K |
| D0145 |
Oral evaluation for a patient under three years of age |
472 |
462 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,856 |
2,791 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,326 |
1,290 |
$28K |
| D1110 |
Prophylaxis - adult |
474 |
463 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,128 |
623 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
968 |
898 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
61 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$441.86 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$191.10 |
| D0603 |
|
4,334 |
4,224 |
$0.00 |