| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,237 |
485 |
$110K |
| D1120 |
Prophylaxis - child |
2,601 |
2,139 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,001 |
793 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,010 |
754 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,464 |
1,207 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
265 |
107 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
533 |
481 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
935 |
739 |
$13K |
| D0330 |
Panoramic radiographic image |
533 |
443 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
135 |
$9K |
| D0272 |
Bitewings - two radiographic images |
483 |
353 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
26 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
255 |
198 |
$2K |
| D0274 |
Bitewings - four radiographic images |
105 |
95 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
176 |
117 |
$2K |