| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,447 |
851 |
$137K |
| D1110 |
Prophylaxis - adult |
1,963 |
1,954 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,212 |
652 |
$68K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,405 |
2,226 |
$59K |
| D1206 |
Topical application of fluoride varnish |
3,800 |
3,781 |
$59K |
| D1120 |
Prophylaxis - child |
1,800 |
1,794 |
$52K |
| D0330 |
Panoramic radiographic image |
1,066 |
1,064 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,442 |
1,412 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,993 |
1,984 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,342 |
2,180 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,672 |
1,661 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
385 |
195 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
741 |
741 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,091 |
1,014 |
$15K |
| D0274 |
Bitewings - four radiographic images |
292 |
292 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
24 |
$5K |
| D0350 |
|
93 |
93 |
$3K |
| D1351 |
Sealant - per tooth |
64 |
25 |
$1K |
| D7111 |
|
17 |
13 |
$983.50 |