| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
721 |
451 |
$77K |
| D1110 |
Prophylaxis - adult |
1,590 |
1,590 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,562 |
2,562 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,734 |
2,733 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
337 |
90 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,826 |
2,651 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
278 |
167 |
$39K |
| D0330 |
Panoramic radiographic image |
718 |
718 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,100 |
1,100 |
$33K |
| D1120 |
Prophylaxis - child |
1,082 |
1,082 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,211 |
1,990 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
356 |
352 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
346 |
288 |
$9K |
| D1351 |
Sealant - per tooth |
244 |
60 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
155 |
$5K |
| D0272 |
Bitewings - two radiographic images |
248 |
248 |
$5K |
| D2332 |
|
18 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
26 |
$2K |
| D0602 |
|
14 |
14 |
$128.10 |