| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
459 |
346 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
445 |
322 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,280 |
1,246 |
$30K |
| D1110 |
Prophylaxis - adult |
619 |
609 |
$29K |
| D1120 |
Prophylaxis - child |
705 |
681 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
769 |
742 |
$22K |
| D0330 |
Panoramic radiographic image |
315 |
312 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
275 |
$15K |
| D0272 |
Bitewings - two radiographic images |
461 |
438 |
$12K |
| D0274 |
Bitewings - four radiographic images |
349 |
347 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
445 |
424 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
24 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66 |
53 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
83 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$395.95 |