| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
906 |
503 |
$122K |
| D1110 |
Prophylaxis - adult |
789 |
786 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
680 |
673 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
164 |
108 |
$27K |
| D0330 |
Panoramic radiographic image |
536 |
530 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
140 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
570 |
566 |
$18K |
| D0274 |
Bitewings - four radiographic images |
720 |
715 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
854 |
728 |
$17K |
| D1120 |
Prophylaxis - child |
269 |
266 |
$12K |
| D1206 |
Topical application of fluoride varnish |
427 |
424 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
317 |
$4K |
| D1330 |
|
348 |
346 |
$2K |
| D0272 |
Bitewings - two radiographic images |
63 |
63 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$567.12 |