| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
511 |
362 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,080 |
1,023 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
349 |
292 |
$23K |
| D1120 |
Prophylaxis - child |
1,010 |
948 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
860 |
782 |
$22K |
| D1206 |
Topical application of fluoride varnish |
653 |
621 |
$13K |
| D0330 |
Panoramic radiographic image |
211 |
192 |
$6K |
| D0274 |
Bitewings - four radiographic images |
315 |
277 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
27 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
202 |
172 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$994.80 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$841.00 |
| D0272 |
Bitewings - two radiographic images |
34 |
34 |
$406.03 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
28 |
$265.20 |