| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
67 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
398 |
398 |
$11K |
| D1120 |
Prophylaxis - child |
251 |
251 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
731 |
395 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
492 |
492 |
$7K |
| D1110 |
Prophylaxis - adult |
117 |
117 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
427 |
424 |
$5K |
| D0274 |
Bitewings - four radiographic images |
139 |
139 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
179 |
161 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$388.52 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$303.94 |
| D0601 |
|
74 |
74 |
$0.00 |
| D0602 |
|
147 |
147 |
$0.00 |
| D0603 |
|
182 |
182 |
$0.00 |