| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
329 |
231 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
394 |
247 |
$49K |
| D1120 |
Prophylaxis - child |
802 |
750 |
$40K |
| D0330 |
Panoramic radiographic image |
381 |
347 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,120 |
1,043 |
$30K |
| D1110 |
Prophylaxis - adult |
440 |
416 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
824 |
777 |
$29K |
| D0274 |
Bitewings - four radiographic images |
477 |
461 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
365 |
330 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
482 |
351 |
$15K |
| D0272 |
Bitewings - two radiographic images |
365 |
344 |
$13K |
| D1351 |
Sealant - per tooth |
319 |
113 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
452 |
433 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
35 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
31 |
$6K |
| D2331 |
|
15 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
36 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
85 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
30 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
27 |
$1K |