| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
302 |
288 |
$13K |
| D1120 |
Prophylaxis - child |
456 |
439 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
638 |
469 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
831 |
799 |
$12K |
| D1110 |
Prophylaxis - adult |
305 |
294 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
76 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
524 |
512 |
$9K |
| D0272 |
Bitewings - two radiographic images |
358 |
344 |
$6K |
| D0274 |
Bitewings - four radiographic images |
264 |
254 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
204 |
194 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
16 |
$944.00 |