| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,845 |
1,816 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
737 |
404 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,564 |
2,529 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,185 |
2,160 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,568 |
1,546 |
$40K |
| D1120 |
Prophylaxis - child |
837 |
829 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
383 |
248 |
$24K |
| D0330 |
Panoramic radiographic image |
413 |
406 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
332 |
323 |
$9K |
| D0272 |
Bitewings - two radiographic images |
130 |
129 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
75 |
73 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
194 |
186 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
45 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$184.50 |