| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
597 |
449 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
601 |
467 |
$92K |
| D0330 |
Panoramic radiographic image |
750 |
738 |
$76K |
| D1206 |
Topical application of fluoride varnish |
1,654 |
1,621 |
$69K |
| D1120 |
Prophylaxis - child |
1,180 |
1,154 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
892 |
878 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,138 |
1,116 |
$46K |
| D1110 |
Prophylaxis - adult |
613 |
607 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,576 |
1,360 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
1,810 |
1,773 |
$43K |
| D0274 |
Bitewings - four radiographic images |
775 |
767 |
$39K |
| D0272 |
Bitewings - two radiographic images |
810 |
798 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
284 |
280 |
$21K |
| D1351 |
Sealant - per tooth |
281 |
83 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
77 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$923.00 |