| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,439 |
982 |
$309K |
| D1120 |
Prophylaxis - child |
4,277 |
4,234 |
$282K |
| D0120 |
Periodic oral evaluation - established patient |
5,641 |
5,596 |
$275K |
| D0274 |
Bitewings - four radiographic images |
4,321 |
4,293 |
$271K |
| D1206 |
Topical application of fluoride varnish |
5,613 |
5,563 |
$230K |
| D1110 |
Prophylaxis - adult |
2,351 |
2,344 |
$207K |
| D1351 |
Sealant - per tooth |
2,813 |
999 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
511 |
394 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
995 |
928 |
$70K |
| D0272 |
Bitewings - two radiographic images |
1,558 |
1,539 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
633 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
291 |
202 |
$52K |
| D0330 |
Panoramic radiographic image |
439 |
437 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
1,128 |
1,118 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
547 |
518 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
306 |
301 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
197 |
196 |
$14K |
| D3120 |
|
47 |
41 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$4K |