| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,911 |
975 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
5,900 |
5,810 |
$117K |
| D1120 |
Prophylaxis - child |
3,841 |
3,786 |
$108K |
| D1110 |
Prophylaxis - adult |
2,505 |
2,462 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,921 |
4,856 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,519 |
1,410 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,130 |
1,121 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
437 |
288 |
$26K |
| D0330 |
Panoramic radiographic image |
485 |
485 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,098 |
1,078 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
56 |
$10K |
| D1206 |
Topical application of fluoride varnish |
562 |
541 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
105 |
60 |
$7K |
| D0272 |
Bitewings - two radiographic images |
405 |
404 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
236 |
$7K |
| D0603 |
|
636 |
620 |
$6K |
| D1354 |
|
168 |
41 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
512 |
212 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
126 |
124 |
$4K |
| D0602 |
|
321 |
321 |
$3K |