| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
992 |
488 |
$68K |
| D1110 |
Prophylaxis - adult |
1,052 |
1,028 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,355 |
1,333 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,485 |
1,453 |
$29K |
| D0274 |
Bitewings - four radiographic images |
964 |
943 |
$23K |
| D1120 |
Prophylaxis - child |
674 |
660 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
580 |
538 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
205 |
142 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
118 |
77 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
203 |
$6K |
| D0330 |
Panoramic radiographic image |
99 |
95 |
$3K |
| D0272 |
Bitewings - two radiographic images |
194 |
190 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
59 |
54 |
$646.68 |
| D1206 |
Topical application of fluoride varnish |
19 |
18 |
$405.90 |