| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
577 |
368 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
297 |
198 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
684 |
677 |
$16K |
| D1110 |
Prophylaxis - adult |
310 |
309 |
$12K |
| D1120 |
Prophylaxis - child |
225 |
225 |
$10K |
| D0330 |
Panoramic radiographic image |
261 |
256 |
$9K |
| D0274 |
Bitewings - four radiographic images |
230 |
228 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
374 |
374 |
$5K |
| D0272 |
Bitewings - two radiographic images |
208 |
207 |
$3K |
| D2332 |
|
41 |
26 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
39 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$577.46 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
25 |
$184.80 |