| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,450 |
735 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
3,738 |
3,602 |
$102K |
| D1110 |
Prophylaxis - adult |
1,620 |
1,562 |
$84K |
| D1120 |
Prophylaxis - child |
2,423 |
2,330 |
$83K |
| D0145 |
Oral evaluation for a patient under three years of age |
597 |
578 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,092 |
2,011 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,972 |
3,831 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
506 |
342 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,541 |
1,492 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,213 |
1,047 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
257 |
251 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
127 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
180 |
149 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
168 |
130 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$394.38 |
| D0603 |
|
4,842 |
4,680 |
$0.00 |