| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
431 |
247 |
$23K |
| D0330 |
Panoramic radiographic image |
328 |
317 |
$22K |
| D1120 |
Prophylaxis - child |
540 |
522 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
366 |
354 |
$11K |
| D1110 |
Prophylaxis - adult |
210 |
206 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
457 |
448 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
29 |
$4K |
| D0274 |
Bitewings - four radiographic images |
505 |
486 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
108 |
86 |
$1K |
| D0272 |
Bitewings - two radiographic images |
127 |
124 |
$1K |
| D0470 |
|
95 |
93 |
$961.70 |
| D1330 |
|
793 |
770 |
$390.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
890 |
743 |
$342.82 |
| D0220 |
Intraoral - periapical first radiographic image |
833 |
798 |
$292.49 |
| D1208 |
Topical application of fluoride, excluding varnish |
798 |
774 |
$259.99 |