| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,034 |
688 |
$75K |
| D1120 |
Prophylaxis - child |
1,875 |
1,825 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,619 |
2,570 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,103 |
2,053 |
$30K |
| D0330 |
Panoramic radiographic image |
661 |
647 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,322 |
1,208 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,597 |
1,551 |
$25K |
| D1110 |
Prophylaxis - adult |
746 |
735 |
$25K |
| D7230 |
|
126 |
41 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
287 |
180 |
$16K |
| D0274 |
Bitewings - four radiographic images |
747 |
736 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
184 |
146 |
$15K |
| D1206 |
Topical application of fluoride varnish |
852 |
834 |
$12K |
| D0240 |
|
706 |
355 |
$12K |
| D1351 |
Sealant - per tooth |
422 |
112 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
46 |
$4K |
| D3120 |
|
111 |
66 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
88 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
104 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
174 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
34 |
34 |
$660.00 |