| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,771 |
1,798 |
$50K |
| D1110 |
Prophylaxis - adult |
1,319 |
845 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,806 |
1,809 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,630 |
1,728 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
582 |
230 |
$37K |
| D1120 |
Prophylaxis - child |
1,259 |
878 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,396 |
845 |
$32K |
| D1351 |
Sealant - per tooth |
482 |
121 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
135 |
98 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
38 |
$4K |
| D0330 |
Panoramic radiographic image |
324 |
238 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
24 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
65 |
$2K |