| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
393 |
233 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
407 |
214 |
$47K |
| D1110 |
Prophylaxis - adult |
927 |
899 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,210 |
1,169 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,754 |
1,706 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
863 |
838 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,218 |
1,178 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
204 |
93 |
$24K |
| D0330 |
Panoramic radiographic image |
486 |
483 |
$24K |
| D1120 |
Prophylaxis - child |
749 |
720 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,335 |
1,295 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,956 |
898 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
235 |
$7K |
| D2394 |
|
34 |
26 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
56 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
92 |
86 |
$2K |