| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
874 |
562 |
$136K |
| D1120 |
Prophylaxis - child |
1,117 |
1,095 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
434 |
308 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,650 |
1,611 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,193 |
1,169 |
$41K |
| D1110 |
Prophylaxis - adult |
522 |
506 |
$38K |
| D0272 |
Bitewings - two radiographic images |
791 |
781 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
417 |
405 |
$27K |
| D0274 |
Bitewings - four radiographic images |
564 |
552 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
212 |
126 |
$21K |
| D0330 |
Panoramic radiographic image |
172 |
166 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
344 |
286 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
245 |
238 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
298 |
292 |
$6K |
| D1351 |
Sealant - per tooth |
135 |
32 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
54 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$3K |