| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
611 |
139 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
806 |
790 |
$22K |
| D1120 |
Prophylaxis - child |
517 |
505 |
$18K |
| D1110 |
Prophylaxis - adult |
341 |
334 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
976 |
960 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
54 |
$14K |
| D0274 |
Bitewings - four radiographic images |
408 |
397 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
788 |
770 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
777 |
738 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
92 |
89 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
194 |
182 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
37 |
36 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
141 |
140 |
$5K |
| D0272 |
Bitewings - two radiographic images |
170 |
167 |
$4K |
| D0602 |
|
721 |
714 |
$0.00 |
| D0603 |
|
298 |
290 |
$0.00 |
| D0601 |
|
45 |
43 |
$0.00 |