| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
858 |
506 |
$89K |
| D1120 |
Prophylaxis - child |
1,084 |
1,084 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,499 |
1,499 |
$31K |
| D1110 |
Prophylaxis - adult |
694 |
694 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,169 |
1,168 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
673 |
626 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,297 |
829 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,062 |
1,054 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
605 |
605 |
$9K |
| D0274 |
Bitewings - four radiographic images |
308 |
308 |
$9K |
| D0272 |
Bitewings - two radiographic images |
397 |
397 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
37 |
$6K |
| D0330 |
Panoramic radiographic image |
119 |
119 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
68 |
$5K |
| D0602 |
|
400 |
400 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$2K |
| D0603 |
|
121 |
121 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$758.50 |