| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,342 |
804 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,189 |
1,142 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
354 |
278 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
866 |
792 |
$37K |
| D0330 |
Panoramic radiographic image |
888 |
841 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
241 |
$29K |
| D1110 |
Prophylaxis - adult |
766 |
731 |
$28K |
| D1120 |
Prophylaxis - child |
989 |
970 |
$27K |
| D1351 |
Sealant - per tooth |
923 |
286 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,765 |
1,153 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,446 |
1,364 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,206 |
1,178 |
$20K |
| D0274 |
Bitewings - four radiographic images |
584 |
547 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
626 |
619 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
245 |
242 |
$9K |
| D0272 |
Bitewings - two radiographic images |
458 |
448 |
$8K |
| D2332 |
|
26 |
17 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
16 |
$1K |