| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
256 |
144 |
$66K |
| D1120 |
Prophylaxis - child |
933 |
913 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,172 |
1,116 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,223 |
1,178 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
196 |
90 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
329 |
312 |
$24K |
| D1110 |
Prophylaxis - adult |
332 |
311 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
891 |
647 |
$20K |
| D0274 |
Bitewings - four radiographic images |
359 |
353 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
732 |
713 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
102 |
52 |
$18K |
| D0272 |
Bitewings - two radiographic images |
247 |
242 |
$10K |
| D0330 |
Panoramic radiographic image |
81 |
78 |
$8K |
| D9920 |
|
46 |
43 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
52 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
41 |
$3K |
| D0160 |
|
12 |
12 |
$2K |
| D0602 |
|
236 |
227 |
$0.00 |
| D0603 |
|
1,054 |
1,008 |
$0.00 |