| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,398 |
942 |
$317K |
| D1120 |
Prophylaxis - child |
5,429 |
5,384 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
6,400 |
6,353 |
$162K |
| D1206 |
Topical application of fluoride varnish |
7,644 |
7,577 |
$161K |
| D1110 |
Prophylaxis - adult |
1,608 |
1,602 |
$83K |
| D0272 |
Bitewings - two radiographic images |
2,177 |
2,169 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,337 |
1,296 |
$42K |
| D0330 |
Panoramic radiographic image |
475 |
473 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
241 |
129 |
$25K |
| D0274 |
Bitewings - four radiographic images |
665 |
662 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
518 |
518 |
$21K |
| D1351 |
Sealant - per tooth |
89 |
25 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
81 |
81 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39 |
39 |
$1K |
| D0240 |
|
34 |
34 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
52 |
$726.34 |