| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
395 |
146 |
$19K |
| D1110 |
Prophylaxis - adult |
561 |
337 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
406 |
$12K |
| D0330 |
Panoramic radiographic image |
440 |
258 |
$10K |
| D1120 |
Prophylaxis - child |
432 |
274 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
487 |
254 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
617 |
405 |
$8K |
| D0274 |
Bitewings - four radiographic images |
491 |
271 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
349 |
208 |
$5K |
| D0272 |
Bitewings - two radiographic images |
153 |
118 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
347 |
191 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
77 |
$2K |
| D1206 |
Topical application of fluoride varnish |
152 |
83 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
12 |
$1K |