| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
778 |
461 |
$54K |
| D1120 |
Prophylaxis - child |
666 |
659 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,093 |
1,084 |
$22K |
| D1110 |
Prophylaxis - adult |
514 |
512 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
807 |
802 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
275 |
177 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
252 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
447 |
435 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
948 |
316 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
197 |
195 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
397 |
393 |
$5K |
| D0274 |
Bitewings - four radiographic images |
192 |
191 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
31 |
$3K |
| D0272 |
Bitewings - two radiographic images |
98 |
97 |
$2K |
| D1999 |
|
25 |
25 |
$0.00 |