| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
153 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
768 |
467 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
494 |
494 |
$15K |
| D1206 |
Topical application of fluoride varnish |
623 |
623 |
$13K |
| D1120 |
Prophylaxis - child |
441 |
441 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
115 |
$12K |
| D0274 |
Bitewings - four radiographic images |
368 |
368 |
$10K |
| D1110 |
Prophylaxis - adult |
221 |
221 |
$9K |
| D0330 |
Panoramic radiographic image |
158 |
158 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
499 |
499 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
174 |
$6K |
| D0272 |
Bitewings - two radiographic images |
236 |
236 |
$6K |
| D1351 |
Sealant - per tooth |
217 |
72 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
24 |
$844.57 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$625.00 |