| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,749 |
890 |
$117K |
| D1110 |
Prophylaxis - adult |
2,105 |
1,931 |
$92K |
| D0274 |
Bitewings - four radiographic images |
1,776 |
1,647 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,579 |
2,389 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
500 |
318 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,582 |
1,488 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
321 |
112 |
$25K |
| D1120 |
Prophylaxis - child |
894 |
840 |
$23K |
| D0330 |
Panoramic radiographic image |
486 |
447 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
817 |
685 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
623 |
550 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
563 |
534 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
176 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,018 |
864 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
183 |
161 |
$7K |
| D2332 |
|
41 |
26 |
$4K |
| D1206 |
Topical application of fluoride varnish |
226 |
204 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
358 |
278 |
$3K |
| D2331 |
|
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
30 |
27 |
$626.19 |