| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,149 |
576 |
$79K |
| D1110 |
Prophylaxis - adult |
1,751 |
1,597 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,973 |
2,723 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
922 |
527 |
$48K |
| D1120 |
Prophylaxis - child |
1,383 |
1,275 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,243 |
2,077 |
$30K |
| D0330 |
Panoramic radiographic image |
608 |
562 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,432 |
1,302 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,017 |
944 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
137 |
86 |
$12K |
| D1206 |
Topical application of fluoride varnish |
835 |
733 |
$10K |
| D1999 |
|
521 |
394 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
55 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
29 |
$646.80 |