| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
70 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
298 |
$18K |
| D1120 |
Prophylaxis - child |
304 |
290 |
$15K |
| D1351 |
Sealant - per tooth |
408 |
70 |
$15K |
| D1206 |
Topical application of fluoride varnish |
482 |
469 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
46 |
$9K |
| D1110 |
Prophylaxis - adult |
111 |
110 |
$8K |
| D0274 |
Bitewings - four radiographic images |
132 |
129 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115 |
99 |
$7K |
| D0272 |
Bitewings - two radiographic images |
185 |
173 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
208 |
201 |
$6K |
| D7111 |
|
27 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
53 |
$1K |
| D0602 |
|
109 |
106 |
$0.00 |
| D0603 |
|
171 |
164 |
$0.00 |
| D0601 |
|
67 |
67 |
$0.00 |