| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,570 |
479 |
$151K |
| D0145 |
Oral evaluation for a patient under three years of age |
350 |
350 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,389 |
1,426 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
629 |
186 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,489 |
1,474 |
$42K |
| D1120 |
Prophylaxis - child |
877 |
864 |
$31K |
| D1110 |
Prophylaxis - adult |
529 |
525 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,892 |
1,868 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,572 |
1,548 |
$19K |
| D0274 |
Bitewings - four radiographic images |
385 |
382 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
420 |
408 |
$11K |
| D2330 |
|
97 |
40 |
$7K |
| D0272 |
Bitewings - two radiographic images |
247 |
247 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
31 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
44 |
$1K |
| D0603 |
|
2,794 |
2,743 |
$0.00 |