| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
603 |
217 |
$58K |
| D1120 |
Prophylaxis - child |
1,425 |
1,395 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,538 |
1,496 |
$41K |
| D1110 |
Prophylaxis - adult |
597 |
579 |
$30K |
| D1206 |
Topical application of fluoride varnish |
2,140 |
2,090 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
388 |
383 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
583 |
566 |
$19K |
| D0272 |
Bitewings - two radiographic images |
859 |
846 |
$19K |
| D0274 |
Bitewings - four radiographic images |
444 |
430 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
63 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
26 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
218 |
195 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
345 |
327 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
285 |
266 |
$3K |
| D0601 |
|
1,793 |
1,776 |
$0.00 |
| D0603 |
|
174 |
170 |
$0.00 |
| D0602 |
|
86 |
86 |
$0.00 |