| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
122 |
$36K |
| D1120 |
Prophylaxis - child |
718 |
695 |
$31K |
| D1206 |
Topical application of fluoride varnish |
954 |
920 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
652 |
626 |
$21K |
| D1351 |
Sealant - per tooth |
516 |
147 |
$20K |
| D0330 |
Panoramic radiographic image |
234 |
231 |
$20K |
| D1110 |
Prophylaxis - adult |
245 |
237 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
214 |
$14K |
| D0274 |
Bitewings - four radiographic images |
311 |
302 |
$14K |
| D0272 |
Bitewings - two radiographic images |
434 |
419 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
73 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
78 |
78 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
16 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$852.00 |