| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
736 |
554 |
$117K |
| D1120 |
Prophylaxis - child |
1,972 |
1,893 |
$94K |
| D1206 |
Topical application of fluoride varnish |
2,708 |
2,613 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,144 |
2,062 |
$72K |
| D1110 |
Prophylaxis - adult |
833 |
816 |
$62K |
| D0330 |
Panoramic radiographic image |
540 |
533 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,327 |
1,274 |
$46K |
| D0274 |
Bitewings - four radiographic images |
959 |
932 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
379 |
308 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
549 |
535 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
219 |
126 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
241 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
183 |
162 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
504 |
489 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
26 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
108 |
98 |
$5K |
| D1351 |
Sealant - per tooth |
38 |
14 |
$2K |