| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
120 |
$19K |
| D1120 |
Prophylaxis - child |
464 |
428 |
$12K |
| D1110 |
Prophylaxis - adult |
339 |
309 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
632 |
592 |
$12K |
| D0330 |
Panoramic radiographic image |
251 |
221 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
93 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
741 |
679 |
$10K |
| D0274 |
Bitewings - four radiographic images |
198 |
179 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
103 |
$3K |
| D0272 |
Bitewings - two radiographic images |
168 |
157 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
247 |
217 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
98 |
76 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
196 |
169 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$395.85 |