| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
351 |
175 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
184 |
183 |
$12K |
| D1351 |
Sealant - per tooth |
434 |
131 |
$11K |
| D1120 |
Prophylaxis - child |
290 |
281 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
809 |
248 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
257 |
250 |
$8K |
| D1110 |
Prophylaxis - adult |
153 |
150 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
270 |
260 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
61 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
443 |
431 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
186 |
181 |
$5K |
| D0274 |
Bitewings - four radiographic images |
112 |
107 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
260 |
248 |
$3K |
| D0272 |
Bitewings - two radiographic images |
34 |
34 |
$769.20 |
| D0603 |
|
482 |
468 |
$0.00 |