| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
489 |
265 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,276 |
1,200 |
$22K |
| D1110 |
Prophylaxis - adult |
629 |
587 |
$21K |
| D1120 |
Prophylaxis - child |
818 |
762 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,491 |
1,401 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
481 |
358 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
72 |
$6K |
| D0274 |
Bitewings - four radiographic images |
277 |
256 |
$6K |
| D1999 |
|
333 |
285 |
$5K |
| D0272 |
Bitewings - two radiographic images |
272 |
263 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
96 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
34 |
$358.05 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$334.95 |