| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
399 |
223 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
576 |
543 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
791 |
746 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
350 |
119 |
$19K |
| D1110 |
Prophylaxis - adult |
351 |
337 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
128 |
34 |
$11K |
| D4342 |
|
266 |
88 |
$8K |
| D7250 |
|
83 |
17 |
$8K |
| D1206 |
Topical application of fluoride varnish |
315 |
299 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
268 |
260 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
61 |
$6K |
| D0330 |
Panoramic radiographic image |
154 |
142 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
222 |
202 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
131 |
100 |
$3K |
| D0274 |
Bitewings - four radiographic images |
136 |
130 |
$3K |
| D2331 |
|
43 |
25 |
$3K |
| D4910 |
|
26 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
130 |
122 |
$1K |