| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,079 |
1,126 |
$147K |
| D1110 |
Prophylaxis - adult |
1,773 |
1,706 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,714 |
2,619 |
$64K |
| D1120 |
Prophylaxis - child |
1,805 |
1,744 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
908 |
524 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,633 |
2,539 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
857 |
830 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
684 |
211 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
796 |
764 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
158 |
38 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
688 |
649 |
$20K |
| D0274 |
Bitewings - four radiographic images |
721 |
689 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,503 |
1,436 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
209 |
128 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,400 |
619 |
$13K |
| D1206 |
Topical application of fluoride varnish |
279 |
273 |
$6K |
| D0272 |
Bitewings - two radiographic images |
228 |
220 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
92 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |