| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
628 |
439 |
$90K |
| D9920 |
|
1,629 |
469 |
$84K |
| D4341 |
|
492 |
129 |
$78K |
| D0350 |
|
1,569 |
766 |
$46K |
| D1110 |
Prophylaxis - adult |
882 |
842 |
$45K |
| D1120 |
Prophylaxis - child |
732 |
710 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
457 |
316 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
884 |
845 |
$32K |
| D0274 |
Bitewings - four radiographic images |
871 |
842 |
$29K |
| D0330 |
Panoramic radiographic image |
504 |
483 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,415 |
1,321 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,145 |
1,079 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
752 |
728 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,818 |
1,092 |
$18K |
| D3120 |
|
430 |
262 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
48 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
248 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
149 |
124 |
$6K |
| D1310 |
|
165 |
161 |
$6K |
| D2332 |
|
45 |
28 |
$6K |
| D1330 |
|
225 |
219 |
$5K |
| D0272 |
Bitewings - two radiographic images |
101 |
96 |
$3K |
| D0425 |
|
28 |
26 |
$775.11 |