| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
847 |
115 |
$54K |
| D1120 |
Prophylaxis - child |
2,314 |
1,699 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,206 |
659 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
777 |
727 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,737 |
1,246 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
479 |
38 |
$9K |
| D0272 |
Bitewings - two radiographic images |
740 |
446 |
$6K |
| D0330 |
Panoramic radiographic image |
434 |
208 |
$4K |
| D0274 |
Bitewings - four radiographic images |
304 |
173 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
66 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
56 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
125 |
92 |
$2K |
| D0350 |
|
66 |
55 |
$1K |
| D1999 |
|
369 |
328 |
$0.00 |