| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
457 |
169 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
891 |
891 |
$25K |
| D1120 |
Prophylaxis - child |
492 |
492 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
935 |
935 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,039 |
997 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
411 |
348 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
913 |
905 |
$10K |
| D0272 |
Bitewings - two radiographic images |
351 |
351 |
$8K |
| D1110 |
Prophylaxis - adult |
135 |
135 |
$7K |
| D0274 |
Bitewings - four radiographic images |
137 |
137 |
$5K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |
| D0603 |
|
840 |
838 |
$0.00 |
| D0602 |
|
15 |
15 |
$0.00 |