| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,324 |
1,450 |
$139K |
| D1120 |
Prophylaxis - child |
2,399 |
2,371 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,447 |
3,382 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,067 |
3,018 |
$42K |
| D1110 |
Prophylaxis - adult |
896 |
871 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
828 |
609 |
$36K |
| D0330 |
Panoramic radiographic image |
1,020 |
1,005 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
796 |
619 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
401 |
294 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,489 |
1,466 |
$24K |
| D0274 |
Bitewings - four radiographic images |
688 |
676 |
$19K |
| D7111 |
|
330 |
209 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
230 |
228 |
$6K |