| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
880 |
409 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,890 |
3,427 |
$76K |
| D1110 |
Prophylaxis - adult |
1,410 |
1,403 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,840 |
2,815 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,906 |
3,835 |
$59K |
| D0330 |
Panoramic radiographic image |
1,102 |
1,092 |
$54K |
| D1206 |
Topical application of fluoride varnish |
3,050 |
3,025 |
$52K |
| D1120 |
Prophylaxis - child |
1,725 |
1,701 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,681 |
1,661 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
948 |
919 |
$28K |
| D0240 |
|
796 |
425 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
143 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
450 |
$13K |
| D1351 |
Sealant - per tooth |
459 |
132 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
91 |
38 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
222 |
215 |
$6K |
| D9248 |
|
44 |
43 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
15 |
$3K |
| D0272 |
Bitewings - two radiographic images |
108 |
108 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
12 |
$389.03 |