| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
334 |
66 |
$18K |
| D1120 |
Prophylaxis - child |
200 |
195 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
308 |
290 |
$6K |
| D0272 |
Bitewings - two radiographic images |
198 |
192 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
12 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
174 |
$3K |
| D1206 |
Topical application of fluoride varnish |
107 |
107 |
$2K |
| D1110 |
Prophylaxis - adult |
45 |
45 |
$2K |
| D0274 |
Bitewings - four radiographic images |
47 |
45 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
52 |
$1K |