| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
747 |
335 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,240 |
1,062 |
$56K |
| D1110 |
Prophylaxis - adult |
1,307 |
1,091 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
775 |
652 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,441 |
1,262 |
$38K |
| D1120 |
Prophylaxis - child |
579 |
577 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
273 |
148 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,157 |
1,134 |
$21K |
| D1206 |
Topical application of fluoride varnish |
492 |
489 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
157 |
147 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
302 |
297 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
39 |
24 |
$476.30 |
| D9986 |
|
218 |
192 |
$0.00 |