| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,004 |
488 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,141 |
2,122 |
$61K |
| D1120 |
Prophylaxis - child |
1,342 |
1,332 |
$48K |
| D1110 |
Prophylaxis - adult |
887 |
880 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,351 |
2,331 |
$34K |
| D0274 |
Bitewings - four radiographic images |
951 |
943 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,370 |
1,035 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,159 |
1,147 |
$14K |
| D0272 |
Bitewings - two radiographic images |
313 |
313 |
$7K |
| D0330 |
Panoramic radiographic image |
99 |
99 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
148 |
142 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
13 |
$459.16 |
| D0601 |
|
182 |
182 |
$0.00 |
| D0602 |
|
2,081 |
2,065 |
$0.00 |
| D0603 |
|
95 |
94 |
$0.00 |