| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,404 |
447 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
1,889 |
1,492 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,559 |
1,471 |
$60K |
| D1120 |
Prophylaxis - child |
1,869 |
1,752 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,456 |
1,359 |
$32K |
| D0330 |
Panoramic radiographic image |
742 |
667 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,041 |
743 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
222 |
125 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,086 |
968 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
268 |
151 |
$22K |
| D1351 |
Sealant - per tooth |
412 |
60 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
970 |
797 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
141 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
46 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
272 |
266 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
192 |
157 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
25 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
164 |
87 |
$1K |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$601.39 |