| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
735 |
370 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,315 |
1,060 |
$45K |
| D1110 |
Prophylaxis - adult |
1,030 |
864 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
691 |
546 |
$27K |
| D1120 |
Prophylaxis - child |
584 |
469 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
714 |
602 |
$15K |
| D1351 |
Sealant - per tooth |
544 |
83 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
126 |
$13K |
| D0274 |
Bitewings - four radiographic images |
503 |
389 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
51 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
694 |
496 |
$10K |
| D1206 |
Topical application of fluoride varnish |
332 |
318 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
197 |
171 |
$6K |
| D0330 |
Panoramic radiographic image |
188 |
129 |
$5K |
| D0272 |
Bitewings - two radiographic images |
275 |
213 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
453 |
343 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
82 |
29 |
$510.18 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
12 |
$308.88 |