| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,185 |
569 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
3,411 |
3,268 |
$87K |
| D1110 |
Prophylaxis - adult |
1,886 |
1,762 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,207 |
3,068 |
$51K |
| D1120 |
Prophylaxis - child |
1,830 |
1,751 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,209 |
2,043 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,401 |
1,840 |
$28K |
| D0274 |
Bitewings - four radiographic images |
844 |
787 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
286 |
255 |
$12K |
| D0272 |
Bitewings - two radiographic images |
389 |
370 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
17 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
69 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
62 |
56 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$2K |
| D4355 |
|
25 |
25 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
14 |
$224.77 |