| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,484 |
825 |
$164K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,593 |
1,311 |
$59K |
| D1110 |
Prophylaxis - adult |
1,063 |
1,022 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
281 |
145 |
$45K |
| D1120 |
Prophylaxis - child |
1,142 |
1,065 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
951 |
900 |
$41K |
| D0330 |
Panoramic radiographic image |
568 |
544 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,162 |
1,089 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,213 |
1,151 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,247 |
1,184 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,524 |
1,424 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
185 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,292 |
1,066 |
$20K |
| D1206 |
Topical application of fluoride varnish |
178 |
158 |
$4K |
| D2931 |
|
25 |
13 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
59 |
$825.00 |