| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
313 |
149 |
$18K |
| D1110 |
Prophylaxis - adult |
307 |
303 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
172 |
98 |
$12K |
| D1206 |
Topical application of fluoride varnish |
512 |
507 |
$10K |
| D0274 |
Bitewings - four radiographic images |
357 |
355 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
334 |
295 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
353 |
350 |
$8K |
| D1120 |
Prophylaxis - child |
215 |
214 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$1K |