| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
535 |
316 |
$38K |
| D1110 |
Prophylaxis - adult |
427 |
418 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
165 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
658 |
645 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
412 |
390 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
424 |
414 |
$10K |
| D0274 |
Bitewings - four radiographic images |
398 |
388 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
222 |
$6K |
| D0330 |
Panoramic radiographic image |
161 |
158 |
$4K |
| D1120 |
Prophylaxis - child |
80 |
77 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
155 |
151 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
39 |
37 |
$667.08 |