| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
938 |
311 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
487 |
180 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,407 |
800 |
$26K |
| D1120 |
Prophylaxis - child |
741 |
719 |
$25K |
| D1351 |
Sealant - per tooth |
907 |
230 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
824 |
805 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,094 |
1,069 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
448 |
441 |
$11K |
| D1110 |
Prophylaxis - adult |
208 |
205 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
816 |
796 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
123 |
$8K |
| D0274 |
Bitewings - four radiographic images |
175 |
170 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
141 |
134 |
$4K |
| D0272 |
Bitewings - two radiographic images |
133 |
128 |
$3K |
| D0603 |
|
1,313 |
1,272 |
$0.00 |