| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
391 |
163 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
613 |
598 |
$17K |
| D1351 |
Sealant - per tooth |
567 |
126 |
$13K |
| D1110 |
Prophylaxis - adult |
258 |
253 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
947 |
916 |
$13K |
| D0274 |
Bitewings - four radiographic images |
495 |
477 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
342 |
281 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
928 |
879 |
$9K |
| D1120 |
Prophylaxis - child |
255 |
245 |
$9K |
| D0350 |
|
657 |
623 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
925 |
732 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
166 |
156 |
$5K |
| D0330 |
Panoramic radiographic image |
173 |
161 |
$3K |
| D0272 |
Bitewings - two radiographic images |
114 |
107 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$706.40 |
| D0603 |
|
1,211 |
1,165 |
$0.00 |