| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
876 |
505 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
1,551 |
1,537 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
4,642 |
4,519 |
$57K |
| D1110 |
Prophylaxis - adult |
1,125 |
1,125 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,056 |
1,056 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,554 |
1,554 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,308 |
1,308 |
$21K |
| D2954 |
|
139 |
122 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
170 |
109 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,008 |
1,855 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
678 |
678 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
26 |
$15K |
| D1120 |
Prophylaxis - child |
215 |
215 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
57 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
194 |
180 |
$6K |
| D0330 |
Panoramic radiographic image |
151 |
151 |
$6K |
| D2394 |
|
12 |
12 |
$2K |
| D0270 |
|
31 |
30 |
$387.50 |