| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
637 |
422 |
$54K |
| D0330 |
Panoramic radiographic image |
881 |
864 |
$48K |
| D1120 |
Prophylaxis - child |
1,154 |
1,128 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,191 |
1,163 |
$31K |
| D1110 |
Prophylaxis - adult |
582 |
566 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
416 |
280 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
466 |
454 |
$20K |
| D0272 |
Bitewings - two radiographic images |
896 |
872 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
834 |
815 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
786 |
724 |
$11K |
| D1206 |
Topical application of fluoride varnish |
423 |
422 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
255 |
196 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
484 |
443 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$461.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
25 |
$335.34 |