| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
937 |
395 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,102 |
2,008 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,286 |
1,136 |
$51K |
| D1110 |
Prophylaxis - adult |
1,374 |
1,277 |
$50K |
| D0330 |
Panoramic radiographic image |
828 |
748 |
$45K |
| D1120 |
Prophylaxis - child |
1,520 |
1,438 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,405 |
2,253 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,141 |
1,033 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,356 |
2,133 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,443 |
1,736 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
128 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
387 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
106 |
52 |
$13K |
| D4355 |
|
115 |
103 |
$7K |
| D0272 |
Bitewings - two radiographic images |
242 |
231 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
26 |
$1K |
| D9986 |
|
160 |
152 |
$0.00 |