| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
874 |
312 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,448 |
1,421 |
$40K |
| D1120 |
Prophylaxis - child |
947 |
925 |
$33K |
| D1110 |
Prophylaxis - adult |
492 |
487 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,449 |
1,423 |
$21K |
| D0274 |
Bitewings - four radiographic images |
503 |
499 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,269 |
1,247 |
$16K |
| D0272 |
Bitewings - two radiographic images |
662 |
646 |
$15K |
| D1351 |
Sealant - per tooth |
544 |
130 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,236 |
1,215 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
429 |
390 |
$11K |
| D0350 |
|
56 |
56 |
$1K |
| D0603 |
|
1,550 |
1,505 |
$0.00 |