| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,273 |
818 |
$132K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,811 |
1,484 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
1,887 |
1,849 |
$58K |
| D1120 |
Prophylaxis - child |
1,442 |
1,418 |
$57K |
| D1110 |
Prophylaxis - adult |
989 |
968 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
608 |
473 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,548 |
1,515 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
203 |
163 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,045 |
1,029 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
313 |
$16K |
| D1206 |
Topical application of fluoride varnish |
493 |
485 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
85 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
158 |
140 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
104 |
$2K |