| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,249 |
3,211 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,724 |
1,610 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
528 |
388 |
$32K |
| D0330 |
Panoramic radiographic image |
114 |
112 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
49 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
88 |
83 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$1K |
| D2140 |
|
15 |
12 |
$951.60 |