| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,125 |
498 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
504 |
277 |
$32K |
| D1110 |
Prophylaxis - adult |
659 |
601 |
$23K |
| D0330 |
Panoramic radiographic image |
696 |
631 |
$23K |
| D1120 |
Prophylaxis - child |
519 |
462 |
$21K |
| D0274 |
Bitewings - four radiographic images |
893 |
819 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
528 |
477 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
379 |
196 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
196 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
541 |
502 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
681 |
603 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
709 |
628 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,088 |
998 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,416 |
806 |
$5K |
| D2394 |
|
36 |
26 |
$2K |
| D2332 |
|
24 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
13 |
$663.00 |
| D1351 |
Sealant - per tooth |
37 |
12 |
$523.69 |