| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
77 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
276 |
265 |
$7K |
| D1351 |
Sealant - per tooth |
265 |
69 |
$7K |
| D1120 |
Prophylaxis - child |
173 |
167 |
$6K |
| D0274 |
Bitewings - four radiographic images |
143 |
132 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
282 |
271 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
283 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
284 |
268 |
$3K |
| D1110 |
Prophylaxis - adult |
47 |
46 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
99 |
90 |
$2K |
| D0272 |
Bitewings - two radiographic images |
90 |
88 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
16 |
$2K |
| D0603 |
|
329 |
319 |
$0.00 |