| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
524 |
346 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
339 |
226 |
$37K |
| D0274 |
Bitewings - four radiographic images |
876 |
853 |
$34K |
| D1120 |
Prophylaxis - child |
720 |
692 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
481 |
463 |
$25K |
| D1206 |
Topical application of fluoride varnish |
964 |
935 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
624 |
602 |
$22K |
| D1110 |
Prophylaxis - adult |
360 |
356 |
$20K |
| D0330 |
Panoramic radiographic image |
310 |
300 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
250 |
213 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
128 |
126 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
233 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
42 |
16 |
$849.00 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$438.00 |