| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,848 |
1,848 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
906 |
601 |
$87K |
| D0330 |
Panoramic radiographic image |
1,097 |
1,097 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,209 |
2,209 |
$50K |
| D1120 |
Prophylaxis - child |
1,349 |
1,349 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,380 |
2,380 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,608 |
2,608 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
295 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
769 |
769 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
143 |
81 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
536 |
531 |
$20K |
| D0274 |
Bitewings - four radiographic images |
572 |
572 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
97 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
346 |
342 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
461 |
457 |
$6K |
| D1351 |
Sealant - per tooth |
158 |
40 |
$5K |
| D0160 |
|
29 |
29 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |