| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,210 |
654 |
$132K |
| D1110 |
Prophylaxis - adult |
719 |
706 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,142 |
1,126 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,383 |
1,360 |
$29K |
| D1120 |
Prophylaxis - child |
711 |
693 |
$23K |
| D0272 |
Bitewings - two radiographic images |
959 |
947 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
99 |
$13K |
| D0330 |
Panoramic radiographic image |
218 |
215 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
285 |
243 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
209 |
207 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
566 |
538 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
24 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$114.90 |