| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
163 |
69 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
230 |
223 |
$6K |
| D1120 |
Prophylaxis - child |
163 |
156 |
$6K |
| D0274 |
Bitewings - four radiographic images |
148 |
145 |
$5K |
| D1110 |
Prophylaxis - adult |
87 |
85 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
243 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
331 |
228 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
262 |
248 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
63 |
$2K |
| D0272 |
Bitewings - two radiographic images |
85 |
81 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
12 |
$1K |
| D0603 |
|
77 |
67 |
$0.00 |
| D0602 |
|
299 |
253 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |