| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
149 |
$17K |
| D1206 |
Topical application of fluoride varnish |
662 |
657 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
512 |
508 |
$13K |
| D1110 |
Prophylaxis - adult |
290 |
286 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
401 |
395 |
$12K |
| D1120 |
Prophylaxis - child |
331 |
331 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
169 |
77 |
$10K |
| D0330 |
Panoramic radiographic image |
255 |
252 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
97 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
156 |
$8K |
| D0274 |
Bitewings - four radiographic images |
267 |
266 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
496 |
489 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
156 |
150 |
$5K |
| D4346 |
|
99 |
99 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
32 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
385 |
374 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
105 |
$2K |
| D0272 |
Bitewings - two radiographic images |
123 |
123 |
$2K |