| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,015 |
1,361 |
$129K |
| D1120 |
Prophylaxis - child |
6,098 |
4,425 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
6,357 |
4,532 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,491 |
737 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,085 |
3,700 |
$42K |
| D1110 |
Prophylaxis - adult |
2,087 |
1,473 |
$40K |
| D0272 |
Bitewings - two radiographic images |
3,125 |
2,269 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,283 |
878 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
782 |
519 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
340 |
230 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
119 |
66 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
175 |
117 |
$4K |
| D0330 |
Panoramic radiographic image |
112 |
88 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
440 |
277 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
27 |
$210.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
12 |
$168.10 |