| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
875 |
372 |
$219K |
| D1120 |
Prophylaxis - child |
1,865 |
1,775 |
$98K |
| D1351 |
Sealant - per tooth |
1,923 |
363 |
$80K |
| D1206 |
Topical application of fluoride varnish |
2,043 |
1,946 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,393 |
1,324 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
745 |
660 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
746 |
687 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
1,228 |
1,134 |
$30K |
| D0272 |
Bitewings - two radiographic images |
822 |
774 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,219 |
865 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
336 |
325 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
40 |
$12K |
| D9920 |
|
67 |
64 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
25 |
$9K |
| D1110 |
Prophylaxis - adult |
101 |
97 |
$7K |
| D0330 |
Panoramic radiographic image |
78 |
73 |
$6K |
| D0274 |
Bitewings - four radiographic images |
80 |
75 |
$4K |
| D0603 |
|
2,218 |
2,040 |
$0.00 |