| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,035 |
587 |
$84K |
| D1120 |
Prophylaxis - child |
1,329 |
1,329 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,726 |
1,726 |
$32K |
| D1110 |
Prophylaxis - adult |
660 |
660 |
$26K |
| D0330 |
Panoramic radiographic image |
566 |
566 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,887 |
1,887 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
938 |
892 |
$22K |
| D0274 |
Bitewings - four radiographic images |
519 |
519 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
329 |
329 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
88 |
$8K |
| D0272 |
Bitewings - two radiographic images |
433 |
433 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
225 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
40 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
173 |
$2K |
| D3221 |
|
19 |
13 |
$2K |