| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
715 |
443 |
$134K |
| D1120 |
Prophylaxis - child |
1,650 |
1,627 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,046 |
2,012 |
$85K |
| D1206 |
Topical application of fluoride varnish |
2,033 |
1,998 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
541 |
372 |
$79K |
| D0330 |
Panoramic radiographic image |
743 |
741 |
$69K |
| D1110 |
Prophylaxis - adult |
789 |
771 |
$59K |
| D0272 |
Bitewings - two radiographic images |
1,415 |
1,395 |
$55K |
| D0274 |
Bitewings - four radiographic images |
862 |
845 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
453 |
446 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
337 |
332 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
748 |
730 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
394 |
288 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
232 |
227 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
32 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
29 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$899.00 |