| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
837 |
527 |
$123K |
| D1120 |
Prophylaxis - child |
866 |
854 |
$39K |
| D1110 |
Prophylaxis - adult |
693 |
684 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
716 |
708 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,266 |
1,247 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,011 |
1,003 |
$32K |
| D0330 |
Panoramic radiographic image |
431 |
424 |
$31K |
| D0274 |
Bitewings - four radiographic images |
758 |
752 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
142 |
$26K |
| D1351 |
Sealant - per tooth |
681 |
196 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
946 |
918 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
616 |
529 |
$13K |
| D0272 |
Bitewings - two radiographic images |
405 |
400 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
267 |
258 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
208 |
168 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
51 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
144 |
143 |
$3K |
| D2950 |
|
17 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
19 |
19 |
$779.00 |