| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,008 |
616 |
$72K |
| D1120 |
Prophylaxis - child |
896 |
889 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
297 |
196 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,044 |
1,039 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
886 |
880 |
$15K |
| D0272 |
Bitewings - two radiographic images |
720 |
715 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
150 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
124 |
$10K |
| D1110 |
Prophylaxis - adult |
230 |
230 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
284 |
253 |
$6K |
| D0274 |
Bitewings - four radiographic images |
203 |
201 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
80 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
130 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
97 |
$2K |
| D2394 |
|
36 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
128 |
$2K |
| D9630 |
|
41 |
35 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$675.66 |