| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
143 |
107 |
$11K |
| D1120 |
Prophylaxis - child |
267 |
265 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
351 |
347 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
357 |
353 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
229 |
185 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
62 |
$4K |
| D0272 |
Bitewings - two radiographic images |
222 |
219 |
$4K |
| D1110 |
Prophylaxis - adult |
79 |
77 |
$3K |
| D1351 |
Sealant - per tooth |
95 |
44 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
30 |
$2K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$2K |
| D0274 |
Bitewings - four radiographic images |
55 |
54 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
30 |
$660.00 |
| D1206 |
Topical application of fluoride varnish |
35 |
35 |
$615.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$348.00 |
| D0220 |
Intraoral - periapical first radiographic image |
33 |
32 |
$330.00 |