| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,019 |
1,242 |
$214K |
| D1110 |
Prophylaxis - adult |
1,672 |
1,627 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,458 |
2,401 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
2,474 |
2,386 |
$37K |
| D1120 |
Prophylaxis - child |
1,163 |
1,142 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,674 |
1,637 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,245 |
1,990 |
$27K |
| D0274 |
Bitewings - four radiographic images |
852 |
829 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
507 |
493 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
110 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
85 |
65 |
$10K |
| D0330 |
Panoramic radiographic image |
184 |
179 |
$8K |
| D0272 |
Bitewings - two radiographic images |
299 |
295 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
28 |
$2K |
| D1206 |
Topical application of fluoride varnish |
85 |
85 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
40 |
$1K |