| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,138 |
590 |
$45K |
| D1110 |
Prophylaxis - adult |
1,248 |
1,189 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,111 |
2,003 |
$29K |
| D1120 |
Prophylaxis - child |
1,108 |
1,046 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,567 |
1,479 |
$19K |
| D0274 |
Bitewings - four radiographic images |
728 |
685 |
$16K |
| D1351 |
Sealant - per tooth |
882 |
161 |
$13K |
| D0272 |
Bitewings - two radiographic images |
516 |
488 |
$6K |
| D0330 |
Panoramic radiographic image |
74 |
70 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
259 |
249 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
73 |
68 |
$411.64 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
55 |
$183.15 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
25 |
$13.25 |