| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,604 |
396 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
148 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
435 |
423 |
$14K |
| D0330 |
Panoramic radiographic image |
157 |
154 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
395 |
382 |
$9K |
| D1120 |
Prophylaxis - child |
257 |
249 |
$9K |
| D1110 |
Prophylaxis - adult |
158 |
154 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
429 |
417 |
$6K |
| D0272 |
Bitewings - two radiographic images |
155 |
150 |
$3K |
| D0274 |
Bitewings - four radiographic images |
108 |
104 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
265 |
255 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
265 |
255 |
$3K |
| D0603 |
|
340 |
336 |
$0.00 |
| D0602 |
|
50 |
48 |
$0.00 |