| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
589 |
331 |
$50K |
| D1110 |
Prophylaxis - adult |
728 |
700 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
139 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
776 |
744 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
278 |
260 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
374 |
362 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
365 |
$15K |
| D0274 |
Bitewings - four radiographic images |
430 |
412 |
$15K |
| D1120 |
Prophylaxis - child |
374 |
356 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
89 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
101 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
341 |
322 |
$7K |
| D1206 |
Topical application of fluoride varnish |
264 |
253 |
$7K |
| D0330 |
Panoramic radiographic image |
101 |
97 |
$5K |
| D1354 |
|
53 |
15 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
125 |
95 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
212 |
188 |
$3K |
| D1351 |
Sealant - per tooth |
83 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
60 |
58 |
$1K |
| D3120 |
|
211 |
142 |
$0.00 |