| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
622 |
348 |
$48K |
| D1120 |
Prophylaxis - child |
1,994 |
1,538 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,358 |
963 |
$39K |
| D0330 |
Panoramic radiographic image |
1,068 |
828 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,158 |
1,608 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
765 |
538 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,079 |
848 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
124 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
77 |
$13K |
| D1110 |
Prophylaxis - adult |
344 |
255 |
$11K |
| D0274 |
Bitewings - four radiographic images |
441 |
352 |
$11K |
| D0272 |
Bitewings - two radiographic images |
606 |
471 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
304 |
243 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
224 |
174 |
$1K |