| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,950 |
1,050 |
$139K |
| D1110 |
Prophylaxis - adult |
2,950 |
2,904 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
3,521 |
3,467 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,075 |
3,025 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,157 |
1,991 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
972 |
585 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,119 |
2,088 |
$55K |
| D1120 |
Prophylaxis - child |
1,796 |
1,758 |
$53K |
| D0330 |
Panoramic radiographic image |
1,040 |
1,024 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
361 |
230 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
689 |
681 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
646 |
643 |
$13K |
| D0272 |
Bitewings - two radiographic images |
346 |
340 |
$6K |
| D1351 |
Sealant - per tooth |
200 |
71 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
115 |
$1K |
| D2140 |
|
26 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$244.00 |