| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
944 |
457 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,891 |
2,705 |
$50K |
| D1120 |
Prophylaxis - child |
1,613 |
1,533 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,924 |
2,735 |
$39K |
| D1110 |
Prophylaxis - adult |
1,098 |
1,028 |
$36K |
| D1999 |
|
1,820 |
1,674 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
263 |
138 |
$19K |
| D0330 |
Panoramic radiographic image |
204 |
190 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
225 |
203 |
$4K |
| D0274 |
Bitewings - four radiographic images |
114 |
109 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
205 |
185 |
$2K |
| D0272 |
Bitewings - two radiographic images |
41 |
40 |
$656.10 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$120.00 |