| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
471 |
225 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,153 |
2,046 |
$51K |
| D1110 |
Prophylaxis - adult |
1,292 |
1,215 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
423 |
218 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
916 |
868 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,239 |
2,129 |
$34K |
| D1120 |
Prophylaxis - child |
1,032 |
1,016 |
$28K |
| D0274 |
Bitewings - four radiographic images |
602 |
585 |
$18K |
| D0330 |
Panoramic radiographic image |
299 |
289 |
$16K |
| D2394 |
|
93 |
50 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
573 |
549 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
372 |
187 |
$4K |
| D0272 |
Bitewings - two radiographic images |
162 |
156 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$508.02 |
| D1999 |
|
710 |
588 |
$8.36 |