| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
960 |
620 |
$105K |
| D0274 |
Bitewings - four radiographic images |
2,327 |
2,327 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,616 |
2,616 |
$98K |
| D2394 |
|
437 |
324 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
485 |
367 |
$59K |
| D1120 |
Prophylaxis - child |
1,543 |
1,543 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
443 |
263 |
$45K |
| D1351 |
Sealant - per tooth |
633 |
225 |
$33K |
| D1110 |
Prophylaxis - adult |
1,102 |
1,102 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,038 |
1,038 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,575 |
1,575 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
881 |
846 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
73 |
$10K |
| D9110 |
|
94 |
92 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
110 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
163 |
161 |
$3K |