| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
479 |
295 |
$66K |
| D1110 |
Prophylaxis - adult |
1,452 |
1,430 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,443 |
2,395 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,226 |
2,138 |
$43K |
| D9110 |
|
777 |
694 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,528 |
2,425 |
$32K |
| D4910 |
|
426 |
411 |
$30K |
| D0274 |
Bitewings - four radiographic images |
947 |
929 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
530 |
528 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
388 |
383 |
$19K |
| D1206 |
Topical application of fluoride varnish |
822 |
795 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
477 |
469 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
130 |
99 |
$14K |
| D4346 |
|
226 |
222 |
$13K |
| D0460 |
|
310 |
300 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
37 |
$8K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$424.34 |