| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
101 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
751 |
718 |
$19K |
| D1110 |
Prophylaxis - adult |
367 |
345 |
$18K |
| D1120 |
Prophylaxis - child |
517 |
500 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
124 |
41 |
$15K |
| D1206 |
Topical application of fluoride varnish |
663 |
638 |
$14K |
| D0274 |
Bitewings - four radiographic images |
474 |
450 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
792 |
757 |
$11K |
| D0330 |
Panoramic radiographic image |
209 |
199 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
191 |
$10K |
| D0272 |
Bitewings - two radiographic images |
332 |
321 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
812 |
730 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$1K |
| D0240 |
|
57 |
30 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
31 |
$1K |
| D1330 |
|
44 |
44 |
$589.02 |