| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,043 |
1,466 |
$219K |
| D1110 |
Prophylaxis - adult |
2,269 |
2,219 |
$95K |
| D1120 |
Prophylaxis - child |
1,999 |
1,977 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,099 |
661 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,658 |
2,619 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,105 |
3,045 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
574 |
331 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,704 |
1,672 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
787 |
767 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,076 |
1,058 |
$26K |
| D1206 |
Topical application of fluoride varnish |
729 |
721 |
$16K |
| D0330 |
Panoramic radiographic image |
232 |
232 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
223 |
173 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
442 |
412 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
136 |
$3K |
| D0272 |
Bitewings - two radiographic images |
128 |
128 |
$2K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$1K |
| D1999 |
|
49 |
45 |
$0.00 |