| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,697 |
845 |
$96K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
641 |
390 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
712 |
454 |
$25K |
| D0330 |
Panoramic radiographic image |
702 |
697 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,141 |
1,125 |
$22K |
| D1120 |
Prophylaxis - child |
1,038 |
1,025 |
$20K |
| D1110 |
Prophylaxis - adult |
801 |
798 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
913 |
793 |
$18K |
| D0274 |
Bitewings - four radiographic images |
841 |
833 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
78 |
$11K |
| D1206 |
Topical application of fluoride varnish |
1,065 |
1,059 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,310 |
665 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
920 |
913 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,077 |
993 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
282 |
274 |
$6K |
| D1351 |
Sealant - per tooth |
129 |
52 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
164 |
160 |
$2K |
| D2331 |
|
17 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
226 |
220 |
$1K |