| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
747 |
211 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
566 |
523 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
49 |
$14K |
| D1120 |
Prophylaxis - child |
327 |
302 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
399 |
336 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
668 |
627 |
$9K |
| D0274 |
Bitewings - four radiographic images |
269 |
250 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
497 |
458 |
$5K |
| D1351 |
Sealant - per tooth |
195 |
41 |
$5K |
| D1110 |
Prophylaxis - adult |
106 |
98 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
434 |
393 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
53 |
$2K |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$579.82 |
| D0603 |
|
622 |
589 |
$0.00 |
| D0602 |
|
63 |
61 |
$0.00 |