| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
805 |
414 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
468 |
235 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,315 |
1,287 |
$14K |
| D1110 |
Prophylaxis - adult |
625 |
618 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,187 |
1,163 |
$9K |
| D1120 |
Prophylaxis - child |
629 |
612 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,403 |
986 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,229 |
1,208 |
$7K |
| D0274 |
Bitewings - four radiographic images |
509 |
501 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
173 |
163 |
$4K |
| D1206 |
Topical application of fluoride varnish |
155 |
149 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$351.24 |
| D0272 |
Bitewings - two radiographic images |
27 |
26 |
$213.24 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
12 |
$42.00 |