| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,683 |
760 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
4,470 |
4,293 |
$50K |
| D1120 |
Prophylaxis - child |
2,767 |
2,656 |
$49K |
| D1110 |
Prophylaxis - adult |
2,481 |
2,379 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,470 |
2,370 |
$29K |
| D1206 |
Topical application of fluoride varnish |
2,796 |
2,728 |
$24K |
| D0272 |
Bitewings - two radiographic images |
2,148 |
2,064 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,334 |
3,178 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,050 |
1,008 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,722 |
2,560 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
200 |
122 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
986 |
826 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,013 |
960 |
$7K |
| D1351 |
Sealant - per tooth |
599 |
145 |
$7K |
| D0240 |
|
717 |
511 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
368 |
319 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
28 |
$2K |
| D2331 |
|
24 |
12 |
$649.45 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$336.14 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$306.32 |
| D0601 |
|
14 |
14 |
$0.00 |