| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,110 |
468 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,169 |
3,144 |
$90K |
| D1120 |
Prophylaxis - child |
2,200 |
2,184 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,173 |
2,720 |
$69K |
| D1110 |
Prophylaxis - adult |
1,106 |
1,095 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,397 |
1,380 |
$47K |
| D0145 |
Oral evaluation for a patient under three years of age |
311 |
310 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,869 |
2,838 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,275 |
2,253 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
401 |
397 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,107 |
1,104 |
$16K |
| D0272 |
Bitewings - two radiographic images |
491 |
487 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
57 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
223 |
210 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
29 |
$953.64 |
| D0603 |
|
4,144 |
4,113 |
$0.00 |