| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,065 |
732 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,165 |
764 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,795 |
3,709 |
$71K |
| D1120 |
Prophylaxis - child |
2,508 |
2,445 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,355 |
4,236 |
$63K |
| D1110 |
Prophylaxis - adult |
1,671 |
1,630 |
$60K |
| D0330 |
Panoramic radiographic image |
735 |
713 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,281 |
1,239 |
$22K |
| D1354 |
|
534 |
226 |
$20K |
| D0274 |
Bitewings - four radiographic images |
774 |
744 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
739 |
718 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
285 |
270 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
191 |
174 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$380.80 |