| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
367 |
153 |
$38K |
| D4355 |
|
535 |
507 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
845 |
732 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,157 |
1,087 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
105 |
$25K |
| D1110 |
Prophylaxis - adult |
507 |
473 |
$17K |
| D0274 |
Bitewings - four radiographic images |
427 |
411 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
250 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
206 |
178 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
508 |
445 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
309 |
290 |
$5K |
| D9110 |
|
64 |
59 |
$2K |
| D2335 |
|
20 |
12 |
$2K |
| D2394 |
|
15 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
130 |
66 |
$1K |
| D1120 |
Prophylaxis - child |
42 |
38 |
$1K |
| D9612 |
|
13 |
13 |
$691.68 |
| D9610 |
|
12 |
12 |
$440.40 |
| D1206 |
Topical application of fluoride varnish |
55 |
41 |
$436.28 |