| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
376 |
231 |
$57K |
| D1120 |
Prophylaxis - child |
906 |
867 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
335 |
205 |
$41K |
| D0330 |
Panoramic radiographic image |
428 |
409 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
925 |
634 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,170 |
1,120 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
818 |
787 |
$29K |
| D1351 |
Sealant - per tooth |
732 |
225 |
$29K |
| D0274 |
Bitewings - four radiographic images |
530 |
522 |
$26K |
| D1110 |
Prophylaxis - adult |
388 |
370 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
399 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
267 |
117 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
836 |
810 |
$19K |
| D0272 |
Bitewings - two radiographic images |
321 |
309 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
166 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
201 |
173 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
13 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
143 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
66 |
$3K |