| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
523 |
289 |
$37K |
| D1110 |
Prophylaxis - adult |
461 |
453 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
326 |
209 |
$19K |
| D1206 |
Topical application of fluoride varnish |
651 |
642 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
456 |
407 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
364 |
358 |
$10K |
| D0330 |
Panoramic radiographic image |
284 |
281 |
$10K |
| D0274 |
Bitewings - four radiographic images |
324 |
319 |
$8K |
| D1120 |
Prophylaxis - child |
238 |
238 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
316 |
314 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
36 |
$4K |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$510.30 |
| D0220 |
Intraoral - periapical first radiographic image |
37 |
36 |
$456.48 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$268.40 |