| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
308 |
164 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,135 |
994 |
$16K |
| D1110 |
Prophylaxis - adult |
531 |
475 |
$15K |
| D1120 |
Prophylaxis - child |
658 |
574 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
285 |
154 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,152 |
1,014 |
$14K |
| D0274 |
Bitewings - four radiographic images |
422 |
381 |
$8K |
| D0272 |
Bitewings - two radiographic images |
511 |
451 |
$7K |
| D0330 |
Panoramic radiographic image |
75 |
66 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
42 |
$1K |