| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,506 |
1,033 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,105 |
510 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,235 |
634 |
$95K |
| D1120 |
Prophylaxis - child |
2,835 |
2,749 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,517 |
2,433 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,278 |
3,184 |
$73K |
| D0330 |
Panoramic radiographic image |
1,641 |
1,591 |
$72K |
| D1206 |
Topical application of fluoride varnish |
3,973 |
3,863 |
$72K |
| D1110 |
Prophylaxis - adult |
1,671 |
1,615 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,257 |
1,211 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,802 |
1,747 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
682 |
632 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
520 |
504 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
368 |
353 |
$4K |