| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,204 |
741 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,699 |
2,673 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,124 |
696 |
$72K |
| D1110 |
Prophylaxis - adult |
1,491 |
1,484 |
$71K |
| D1120 |
Prophylaxis - child |
1,518 |
1,496 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,109 |
2,083 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,537 |
1,520 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
748 |
662 |
$25K |
| D0330 |
Panoramic radiographic image |
139 |
137 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
340 |
330 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
40 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$165.00 |