| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,470 |
693 |
$150K |
| D1120 |
Prophylaxis - child |
4,140 |
3,846 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,289 |
3,110 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
616 |
301 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,086 |
3,816 |
$66K |
| D0330 |
Panoramic radiographic image |
651 |
589 |
$31K |
| D0274 |
Bitewings - four radiographic images |
844 |
771 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
526 |
463 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
420 |
355 |
$13K |
| D1110 |
Prophylaxis - adult |
137 |
122 |
$5K |
| D0272 |
Bitewings - two radiographic images |
209 |
200 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
234 |
$3K |
| D9248 |
|
13 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$730.53 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$391.84 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$303.82 |