| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
300 |
64 |
$28K |
| D1110 |
Prophylaxis - adult |
334 |
307 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
587 |
555 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
217 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
557 |
238 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
214 |
197 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
316 |
283 |
$3K |
| D0330 |
Panoramic radiographic image |
90 |
83 |
$3K |
| D0274 |
Bitewings - four radiographic images |
107 |
94 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
61 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
52 |
$1K |
| D1120 |
Prophylaxis - child |
29 |
28 |
$955.50 |
| D0603 |
|
793 |
745 |
$0.02 |