| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
387 |
236 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
941 |
837 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
122 |
$26K |
| D1110 |
Prophylaxis - adult |
455 |
445 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
675 |
667 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
308 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
744 |
682 |
$11K |
| D9110 |
|
235 |
217 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
614 |
599 |
$10K |
| D0274 |
Bitewings - four radiographic images |
268 |
262 |
$8K |
| D1120 |
Prophylaxis - child |
290 |
284 |
$8K |
| D0330 |
Panoramic radiographic image |
92 |
89 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
32 |
$5K |
| D2332 |
|
46 |
25 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
335 |
121 |
$4K |
| D2394 |
|
16 |
12 |
$3K |
| D2335 |
|
22 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
31 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$464.40 |