| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,028 |
1,410 |
$134K |
| D1120 |
Prophylaxis - child |
4,711 |
4,592 |
$123K |
| D1206 |
Topical application of fluoride varnish |
7,371 |
7,197 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,831 |
1,571 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
4,623 |
4,478 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
935 |
644 |
$49K |
| D1110 |
Prophylaxis - adult |
1,360 |
1,338 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,972 |
1,929 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
599 |
580 |
$29K |
| D1351 |
Sealant - per tooth |
1,232 |
463 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,010 |
980 |
$16K |
| D0274 |
Bitewings - four radiographic images |
423 |
422 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
752 |
724 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
19 |
19 |
$324.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
26 |
$176.95 |