| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,038 |
1,778 |
$207K |
| D1206 |
Topical application of fluoride varnish |
6,616 |
6,472 |
$134K |
| D1120 |
Prophylaxis - child |
4,134 |
4,048 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
5,478 |
5,368 |
$129K |
| D1110 |
Prophylaxis - adult |
3,067 |
3,003 |
$128K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,678 |
1,166 |
$94K |
| D1351 |
Sealant - per tooth |
2,716 |
1,033 |
$69K |
| D0330 |
Panoramic radiographic image |
1,688 |
1,640 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,543 |
2,486 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
547 |
425 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,442 |
2,390 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,026 |
982 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
307 |
199 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,519 |
1,456 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
475 |
458 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
853 |
486 |
$6K |
| D2332 |
|
68 |
40 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
38 |
$865.76 |