| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
140 |
$23K |
| D1206 |
Topical application of fluoride varnish |
558 |
532 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
510 |
405 |
$13K |
| D0330 |
Panoramic radiographic image |
318 |
297 |
$13K |
| D1120 |
Prophylaxis - child |
397 |
382 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
395 |
363 |
$11K |
| D1110 |
Prophylaxis - adult |
259 |
246 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
410 |
403 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
43 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
436 |
171 |
$4K |
| D0272 |
Bitewings - two radiographic images |
203 |
194 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
344 |
317 |
$3K |
| D0274 |
Bitewings - four radiographic images |
142 |
137 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
164 |
162 |
$2K |
| D3120 |
|
54 |
27 |
$1K |