| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
894 |
469 |
$96K |
| D1120 |
Prophylaxis - child |
3,074 |
2,902 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
1,783 |
1,685 |
$70K |
| D0274 |
Bitewings - four radiographic images |
1,918 |
1,813 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,151 |
1,070 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,741 |
1,653 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,327 |
1,287 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,385 |
1,313 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
822 |
711 |
$16K |
| D0330 |
Panoramic radiographic image |
284 |
261 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
29 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
323 |
321 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
25 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
560 |
246 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
58 |
$4K |
| D1110 |
Prophylaxis - adult |
50 |
48 |
$584.69 |
| D0272 |
Bitewings - two radiographic images |
16 |
14 |
$299.39 |