| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
566 |
414 |
$54K |
| D1120 |
Prophylaxis - child |
1,732 |
1,611 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,781 |
1,664 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,083 |
1,939 |
$31K |
| D1110 |
Prophylaxis - adult |
384 |
380 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
242 |
$14K |
| D0272 |
Bitewings - two radiographic images |
419 |
408 |
$10K |
| D1351 |
Sealant - per tooth |
372 |
133 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
70 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
261 |
229 |
$8K |
| D0274 |
Bitewings - four radiographic images |
199 |
199 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$2K |