| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
849 |
468 |
$90K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
470 |
274 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
930 |
855 |
$38K |
| D1110 |
Prophylaxis - adult |
889 |
827 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
251 |
162 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
720 |
668 |
$17K |
| D0274 |
Bitewings - four radiographic images |
539 |
510 |
$15K |
| D2394 |
|
94 |
55 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
903 |
842 |
$13K |
| D1120 |
Prophylaxis - child |
387 |
370 |
$10K |
| D1206 |
Topical application of fluoride varnish |
644 |
589 |
$10K |
| D0330 |
Panoramic radiographic image |
161 |
153 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
685 |
610 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
161 |
117 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
63 |
$2K |
| D2332 |
|
15 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
76 |
73 |
$1K |
| D1330 |
|
20 |
19 |
$0.00 |