| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
558 |
229 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,476 |
1,439 |
$40K |
| D1110 |
Prophylaxis - adult |
607 |
587 |
$31K |
| D1120 |
Prophylaxis - child |
877 |
858 |
$30K |
| D0274 |
Bitewings - four radiographic images |
909 |
863 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,620 |
1,576 |
$23K |
| D1351 |
Sealant - per tooth |
856 |
156 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
288 |
264 |
$7K |
| D0272 |
Bitewings - two radiographic images |
291 |
284 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
13 |
$2K |
| D0601 |
|
374 |
372 |
$0.00 |
| D0602 |
|
548 |
545 |
$0.00 |
| D0603 |
|
546 |
538 |
$0.00 |