| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,199 |
2,040 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
864 |
510 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,437 |
2,254 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
535 |
491 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,630 |
1,515 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
580 |
359 |
$27K |
| D0274 |
Bitewings - four radiographic images |
722 |
672 |
$23K |
| D1120 |
Prophylaxis - child |
723 |
669 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
524 |
478 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
75 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
343 |
303 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
45 |
40 |
$942.78 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
32 |
$677.26 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
15 |
$504.49 |