| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
366 |
140 |
$51K |
| D0350 |
|
1,088 |
622 |
$41K |
| D1120 |
Prophylaxis - child |
853 |
831 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,094 |
1,062 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
503 |
495 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
227 |
$10K |
| D0272 |
Bitewings - two radiographic images |
316 |
312 |
$7K |
| D1354 |
|
584 |
145 |
$5K |
| D9248 |
|
24 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
49 |
49 |
$2K |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
84 |
84 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
36 |
$609.62 |
| D0240 |
|
13 |
13 |
$483.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$397.93 |