| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
850 |
332 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
487 |
187 |
$48K |
| D1120 |
Prophylaxis - child |
912 |
891 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
208 |
111 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
916 |
894 |
$26K |
| D0272 |
Bitewings - two radiographic images |
619 |
604 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
315 |
$18K |
| D1206 |
Topical application of fluoride varnish |
817 |
793 |
$18K |
| D1110 |
Prophylaxis - adult |
229 |
222 |
$13K |
| D0274 |
Bitewings - four radiographic images |
336 |
324 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
269 |
266 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
388 |
384 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
571 |
556 |
$8K |
| D1351 |
Sealant - per tooth |
254 |
94 |
$8K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
155 |
151 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
209 |
204 |
$3K |
| D1999 |
|
39 |
35 |
$0.00 |