| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
831 |
361 |
$80K |
| D1110 |
Prophylaxis - adult |
1,359 |
1,328 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,217 |
2,181 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
319 |
$53K |
| D1120 |
Prophylaxis - child |
1,314 |
1,290 |
$45K |
| D1351 |
Sealant - per tooth |
2,102 |
420 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,536 |
1,483 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,721 |
2,674 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,668 |
2,584 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,780 |
2,700 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
477 |
449 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
102 |
99 |
$13K |
| D0272 |
Bitewings - two radiographic images |
558 |
549 |
$12K |
| D0330 |
Panoramic radiographic image |
456 |
429 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
198 |
181 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
80 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
12 |
$704.66 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$260.48 |
| D0603 |
|
2,304 |
2,260 |
$9.08 |
| D0601 |
|
598 |
594 |
$0.01 |
| D0602 |
|
69 |
67 |
$0.00 |