| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
663 |
518 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
745 |
569 |
$106K |
| D0330 |
Panoramic radiographic image |
707 |
692 |
$68K |
| D1120 |
Prophylaxis - child |
1,040 |
1,017 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,208 |
1,188 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,215 |
1,194 |
$47K |
| D1110 |
Prophylaxis - adult |
537 |
523 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
469 |
456 |
$33K |
| D0274 |
Bitewings - four radiographic images |
600 |
593 |
$30K |
| D0272 |
Bitewings - two radiographic images |
816 |
800 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
230 |
217 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
203 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
595 |
583 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
402 |
254 |
$12K |
| D3120 |
|
87 |
71 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
113 |
102 |
$3K |
| D7111 |
|
22 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
26 |
$963.00 |