| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,140 |
1,429 |
$217K |
| D0330 |
Panoramic radiographic image |
1,867 |
1,858 |
$111K |
| D1110 |
Prophylaxis - adult |
2,114 |
2,113 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,126 |
3,124 |
$89K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
728 |
551 |
$84K |
| D0272 |
Bitewings - two radiographic images |
2,521 |
2,506 |
$53K |
| D1120 |
Prophylaxis - child |
1,359 |
1,353 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,201 |
2,196 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
482 |
348 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,273 |
1,252 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
322 |
315 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
537 |
207 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
25 |
$954.98 |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$600.00 |