| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
561 |
368 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
752 |
550 |
$25K |
| D1120 |
Prophylaxis - child |
800 |
784 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
935 |
917 |
$24K |
| D1110 |
Prophylaxis - adult |
442 |
426 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
946 |
922 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
280 |
192 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
291 |
284 |
$13K |
| D0330 |
Panoramic radiographic image |
173 |
169 |
$9K |
| D0272 |
Bitewings - two radiographic images |
484 |
469 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
54 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
44 |
$426.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
18 |
$136.62 |