| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,522 |
1,243 |
$248K |
| D1110 |
Prophylaxis - adult |
1,953 |
1,911 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,807 |
2,758 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,745 |
1,678 |
$57K |
| D0330 |
Panoramic radiographic image |
1,045 |
1,012 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,485 |
1,458 |
$46K |
| D1120 |
Prophylaxis - child |
1,312 |
1,294 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
715 |
674 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
902 |
889 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
381 |
374 |
$12K |
| D1206 |
Topical application of fluoride varnish |
322 |
317 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
176 |
$2K |