| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,170 |
284 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
499 |
100 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,297 |
1,282 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
320 |
163 |
$26K |
| D1110 |
Prophylaxis - adult |
621 |
613 |
$26K |
| D1120 |
Prophylaxis - child |
722 |
717 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
734 |
730 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
597 |
$17K |
| D0330 |
Panoramic radiographic image |
293 |
290 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
912 |
442 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
561 |
547 |
$7K |
| D2335 |
|
67 |
26 |
$6K |
| D0274 |
Bitewings - four radiographic images |
214 |
212 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
59 |
56 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
108 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56 |
51 |
$2K |
| D9215 |
|
19 |
17 |
$0.00 |