| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,464 |
864 |
$176K |
| D1120 |
Prophylaxis - child |
3,981 |
3,981 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
2,940 |
2,940 |
$102K |
| D1206 |
Topical application of fluoride varnish |
3,718 |
3,718 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
389 |
282 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,772 |
1,933 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
876 |
790 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,638 |
1,638 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,052 |
2,047 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
551 |
551 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
134 |
$5K |
| D0274 |
Bitewings - four radiographic images |
85 |
85 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
44 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
131 |
131 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
30 |
30 |
$1K |