| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
522 |
235 |
$35K |
| D1120 |
Prophylaxis - child |
675 |
649 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
910 |
882 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,050 |
1,016 |
$20K |
| D1110 |
Prophylaxis - adult |
435 |
425 |
$17K |
| D0274 |
Bitewings - four radiographic images |
426 |
417 |
$11K |
| D0272 |
Bitewings - two radiographic images |
373 |
358 |
$6K |
| D0330 |
Panoramic radiographic image |
153 |
149 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
51 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52 |
43 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
38 |
$994.50 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$341.60 |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
31 |
$329.66 |