| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,060 |
649 |
$102K |
| D1120 |
Prophylaxis - child |
2,094 |
2,094 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,829 |
2,829 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,910 |
1,725 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,408 |
3,408 |
$52K |
| D1110 |
Prophylaxis - adult |
1,076 |
1,076 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,556 |
2,467 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
628 |
378 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,237 |
1,237 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
514 |
157 |
$34K |
| D0330 |
Panoramic radiographic image |
514 |
514 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,954 |
1,140 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
608 |
594 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
594 |
594 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
50 |
$9K |
| D1351 |
Sealant - per tooth |
117 |
33 |
$3K |
| D0272 |
Bitewings - two radiographic images |
124 |
124 |
$2K |