| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
870 |
562 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
1,632 |
1,611 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
315 |
242 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
459 |
309 |
$34K |
| D1120 |
Prophylaxis - child |
1,127 |
1,106 |
$28K |
| D1110 |
Prophylaxis - adult |
783 |
775 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
665 |
609 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
456 |
249 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,469 |
1,444 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
294 |
286 |
$12K |
| D1351 |
Sealant - per tooth |
421 |
95 |
$11K |
| D0330 |
Panoramic radiographic image |
175 |
171 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
262 |
252 |
$9K |
| D0272 |
Bitewings - two radiographic images |
477 |
468 |
$8K |
| D0274 |
Bitewings - four radiographic images |
254 |
254 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
457 |
434 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
89 |
$6K |
| D0240 |
|
53 |
25 |
$744.31 |