| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,441 |
434 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
865 |
276 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
549 |
543 |
$36K |
| D1120 |
Prophylaxis - child |
545 |
536 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
554 |
549 |
$18K |
| D1110 |
Prophylaxis - adult |
297 |
287 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
938 |
918 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
304 |
301 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
261 |
251 |
$7K |
| D0272 |
Bitewings - two radiographic images |
159 |
155 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
257 |
249 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
258 |
241 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D0603 |
|
1,242 |
1,127 |
$0.00 |