| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
549 |
313 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,626 |
1,552 |
$28K |
| D1110 |
Prophylaxis - adult |
764 |
738 |
$26K |
| D1120 |
Prophylaxis - child |
999 |
947 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,436 |
1,371 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
214 |
$17K |
| D0330 |
Panoramic radiographic image |
366 |
353 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
708 |
577 |
$13K |
| D0272 |
Bitewings - two radiographic images |
516 |
481 |
$8K |
| D0274 |
Bitewings - four radiographic images |
360 |
346 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34 |
32 |
$682.00 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
25 |
$278.00 |