| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
804 |
473 |
$64K |
| D1354 |
|
1,790 |
496 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
218 |
$24K |
| D1120 |
Prophylaxis - child |
606 |
583 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
513 |
490 |
$15K |
| D0330 |
Panoramic radiographic image |
319 |
305 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
901 |
877 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
489 |
421 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
71 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
535 |
517 |
$10K |
| D0272 |
Bitewings - two radiographic images |
585 |
563 |
$9K |
| D1999 |
|
459 |
408 |
$9K |
| D1110 |
Prophylaxis - adult |
241 |
227 |
$9K |
| D0274 |
Bitewings - four radiographic images |
240 |
225 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
35 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
115 |
$1K |
| D1206 |
Topical application of fluoride varnish |
55 |
50 |
$1K |