| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,282 |
716 |
$121K |
| D1110 |
Prophylaxis - adult |
2,188 |
2,188 |
$110K |
| D0274 |
Bitewings - four radiographic images |
2,053 |
2,053 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
623 |
358 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,303 |
2,303 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
580 |
342 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
311 |
189 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,092 |
2,092 |
$34K |
| D0330 |
Panoramic radiographic image |
596 |
596 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
587 |
524 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
118 |
80 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
340 |
340 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
996 |
980 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
278 |
276 |
$11K |
| D0272 |
Bitewings - two radiographic images |
449 |
449 |
$8K |
| D1120 |
Prophylaxis - child |
234 |
234 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
158 |
158 |
$2K |
| D1351 |
Sealant - per tooth |
47 |
14 |
$1K |