| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,324 |
614 |
$107K |
| D1110 |
Prophylaxis - adult |
1,711 |
1,362 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
1,879 |
1,516 |
$46K |
| D0274 |
Bitewings - four radiographic images |
993 |
790 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
254 |
164 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,066 |
822 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
306 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,099 |
832 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
426 |
348 |
$13K |
| D0330 |
Panoramic radiographic image |
316 |
178 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
355 |
117 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,042 |
789 |
$10K |
| D1120 |
Prophylaxis - child |
263 |
209 |
$9K |
| D2332 |
|
43 |
25 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
56 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
53 |
$3K |