| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
738 |
502 |
$112K |
| D1120 |
Prophylaxis - child |
1,396 |
1,355 |
$64K |
| D1206 |
Topical application of fluoride varnish |
1,895 |
1,832 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,552 |
1,503 |
$51K |
| D1110 |
Prophylaxis - adult |
598 |
573 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
381 |
197 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
231 |
$36K |
| D0272 |
Bitewings - two radiographic images |
883 |
855 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
391 |
382 |
$24K |
| D0330 |
Panoramic radiographic image |
298 |
284 |
$24K |
| D0274 |
Bitewings - four radiographic images |
512 |
491 |
$23K |
| D1351 |
Sealant - per tooth |
587 |
178 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
401 |
378 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
328 |
321 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
600 |
586 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
37 |
$1K |