| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
310 |
92 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
777 |
732 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,748 |
829 |
$18K |
| D0274 |
Bitewings - four radiographic images |
506 |
463 |
$15K |
| D1206 |
Topical application of fluoride varnish |
876 |
832 |
$12K |
| D1110 |
Prophylaxis - adult |
229 |
216 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
934 |
872 |
$11K |
| D0350 |
|
677 |
573 |
$10K |
| D1120 |
Prophylaxis - child |
279 |
263 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
150 |
132 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$350.70 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$161.70 |
| D0602 |
|
918 |
869 |
$0.00 |
| D0603 |
|
28 |
27 |
$0.00 |