| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
796 |
647 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
805 |
582 |
$102K |
| D1120 |
Prophylaxis - child |
1,312 |
1,277 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,450 |
1,422 |
$60K |
| D1206 |
Topical application of fluoride varnish |
1,771 |
1,732 |
$56K |
| D1351 |
Sealant - per tooth |
1,140 |
327 |
$50K |
| D0330 |
Panoramic radiographic image |
428 |
425 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
319 |
263 |
$38K |
| D0272 |
Bitewings - two radiographic images |
931 |
917 |
$33K |
| D1110 |
Prophylaxis - adult |
435 |
430 |
$32K |
| D0274 |
Bitewings - four radiographic images |
624 |
613 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
754 |
741 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
395 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
311 |
291 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
203 |
178 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
211 |
$14K |
| D9110 |
|
84 |
80 |
$6K |
| D0270 |
|
84 |
83 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$398.94 |