| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
308 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
939 |
915 |
$21K |
| D1110 |
Prophylaxis - adult |
495 |
486 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
245 |
193 |
$15K |
| D1120 |
Prophylaxis - child |
320 |
317 |
$14K |
| D0330 |
Panoramic radiographic image |
378 |
366 |
$13K |
| D0274 |
Bitewings - four radiographic images |
383 |
373 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
538 |
530 |
$7K |
| D0272 |
Bitewings - two radiographic images |
285 |
271 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
83 |
$4K |
| D2332 |
|
32 |
24 |
$2K |
| D2394 |
|
17 |
15 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
24 |
$1K |