| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
851 |
587 |
$60K |
| D1110 |
Prophylaxis - adult |
1,451 |
1,417 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,753 |
1,716 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
382 |
273 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,002 |
985 |
$26K |
| D1120 |
Prophylaxis - child |
804 |
795 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,035 |
1,011 |
$20K |
| D1206 |
Topical application of fluoride varnish |
926 |
907 |
$18K |
| D0330 |
Panoramic radiographic image |
488 |
477 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
469 |
457 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
162 |
123 |
$9K |
| D0272 |
Bitewings - two radiographic images |
304 |
300 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
142 |
130 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
96 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
27 |
$634.40 |
| D9630 |
|
48 |
45 |
$101.65 |
| D1999 |
|
178 |
164 |
$0.00 |