| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
273 |
182 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
303 |
291 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
477 |
456 |
$11K |
| D1120 |
Prophylaxis - child |
509 |
490 |
$10K |
| D1351 |
Sealant - per tooth |
563 |
152 |
$10K |
| D1206 |
Topical application of fluoride varnish |
751 |
726 |
$10K |
| D0274 |
Bitewings - four radiographic images |
314 |
306 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
94 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
262 |
216 |
$5K |
| D0272 |
Bitewings - two radiographic images |
345 |
324 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
32 |
$2K |
| D1110 |
Prophylaxis - adult |
51 |
51 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
38 |
$875.80 |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
35 |
$317.64 |