| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
779 |
427 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,055 |
2,330 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,639 |
2,573 |
$40K |
| D1120 |
Prophylaxis - child |
1,221 |
1,193 |
$37K |
| D1110 |
Prophylaxis - adult |
780 |
768 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,660 |
1,632 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,116 |
2,083 |
$34K |
| D1320 |
|
723 |
712 |
$24K |
| D0274 |
Bitewings - four radiographic images |
645 |
638 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
184 |
$18K |
| D0330 |
Panoramic radiographic image |
309 |
309 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
434 |
423 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
26 |
$12K |
| D0350 |
|
370 |
370 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
247 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
292 |
267 |
$7K |
| D0240 |
|
245 |
123 |
$5K |
| D1351 |
Sealant - per tooth |
129 |
39 |
$3K |
| D0601 |
|
79 |
79 |
$722.85 |
| D0603 |
|
69 |
69 |
$631.35 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$439.08 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$188.63 |
| D0602 |
|
12 |
12 |
$109.80 |