| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
810 |
518 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
1,767 |
1,766 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
636 |
439 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
283 |
208 |
$47K |
| D1120 |
Prophylaxis - child |
1,405 |
1,405 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,063 |
2,062 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,221 |
1,220 |
$42K |
| D1110 |
Prophylaxis - adult |
895 |
894 |
$42K |
| D0330 |
Panoramic radiographic image |
573 |
573 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,145 |
745 |
$30K |
| D0272 |
Bitewings - two radiographic images |
814 |
814 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
514 |
514 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
956 |
948 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
156 |
155 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
17 |
$732.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$410.68 |