| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
82 |
$13K |
| D1110 |
Prophylaxis - adult |
175 |
171 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
305 |
299 |
$7K |
| D0274 |
Bitewings - four radiographic images |
226 |
219 |
$6K |
| D1120 |
Prophylaxis - child |
164 |
164 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
449 |
426 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
146 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
44 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
546 |
380 |
$4K |
| D1206 |
Topical application of fluoride varnish |
150 |
150 |
$4K |
| D0330 |
Panoramic radiographic image |
68 |
66 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
88 |
87 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
29 |
$895.59 |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$744.91 |