| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
369 |
239 |
$55K |
| D1120 |
Prophylaxis - child |
1,044 |
997 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,299 |
1,235 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
611 |
583 |
$35K |
| D0330 |
Panoramic radiographic image |
271 |
257 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
694 |
659 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
338 |
$22K |
| D0272 |
Bitewings - two radiographic images |
630 |
605 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
87 |
$17K |
| D1110 |
Prophylaxis - adult |
189 |
173 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
519 |
506 |
$11K |
| D0274 |
Bitewings - four radiographic images |
140 |
129 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
40 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
37 |
$2K |
| D1351 |
Sealant - per tooth |
47 |
17 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
13 |
$667.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
44 |
27 |
$654.00 |