| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
465 |
253 |
$41K |
| D1110 |
Prophylaxis - adult |
749 |
748 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
481 |
480 |
$20K |
| D0274 |
Bitewings - four radiographic images |
645 |
644 |
$20K |
| D1206 |
Topical application of fluoride varnish |
693 |
691 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
698 |
695 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
94 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,132 |
1,113 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
99 |
$10K |
| D1120 |
Prophylaxis - child |
220 |
220 |
$9K |
| D1330 |
|
356 |
353 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
983 |
809 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
122 |
122 |
$4K |
| D0330 |
Panoramic radiographic image |
81 |
81 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
109 |
94 |
$2K |
| D1999 |
|
55 |
52 |
$0.00 |