| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,743 |
493 |
$127K |
| D1110 |
Prophylaxis - adult |
1,715 |
1,089 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
948 |
186 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
429 |
165 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,778 |
1,196 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,177 |
763 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,171 |
623 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,356 |
1,044 |
$20K |
| D1120 |
Prophylaxis - child |
619 |
450 |
$14K |
| D0272 |
Bitewings - two radiographic images |
906 |
708 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,951 |
1,188 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,235 |
690 |
$10K |
| D0330 |
Panoramic radiographic image |
102 |
87 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
194 |
84 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
29 |
$285.00 |
| D1206 |
Topical application of fluoride varnish |
21 |
20 |
$24.29 |
| D0350 |
|
17 |
13 |
$0.00 |