| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
758 |
443 |
$100K |
| D1110 |
Prophylaxis - adult |
1,119 |
1,118 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
398 |
277 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,728 |
1,725 |
$38K |
| D1120 |
Prophylaxis - child |
911 |
898 |
$28K |
| D0274 |
Bitewings - four radiographic images |
920 |
919 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,084 |
2,067 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,906 |
1,889 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
748 |
669 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,379 |
1,369 |
$16K |
| D0272 |
Bitewings - two radiographic images |
732 |
726 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
347 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
55 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
189 |
187 |
$7K |
| D1206 |
Topical application of fluoride varnish |
224 |
217 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
51 |
$2K |