| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
408 |
250 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,496 |
1,445 |
$29K |
| D1120 |
Prophylaxis - child |
1,001 |
970 |
$28K |
| D1206 |
Topical application of fluoride varnish |
841 |
819 |
$19K |
| D1110 |
Prophylaxis - adult |
489 |
458 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
105 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
286 |
261 |
$6K |
| D0330 |
Panoramic radiographic image |
127 |
122 |
$6K |
| D0272 |
Bitewings - two radiographic images |
329 |
318 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
375 |
365 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
154 |
$4K |
| D0274 |
Bitewings - four radiographic images |
84 |
81 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
24 |
$277.20 |