| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,121 |
653 |
$143K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
749 |
471 |
$76K |
| D1120 |
Prophylaxis - child |
1,718 |
1,640 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,536 |
1,632 |
$65K |
| D0330 |
Panoramic radiographic image |
870 |
826 |
$63K |
| D1206 |
Topical application of fluoride varnish |
2,328 |
2,235 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,597 |
1,522 |
$54K |
| D1110 |
Prophylaxis - adult |
765 |
742 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,047 |
1,018 |
$44K |
| D1351 |
Sealant - per tooth |
1,318 |
370 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
837 |
810 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,860 |
1,835 |
$34K |
| D0272 |
Bitewings - two radiographic images |
880 |
844 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
317 |
137 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
94 |
76 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
110 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
79 |
70 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$837.00 |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
28 |
$727.00 |