| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
920 |
472 |
$103K |
| D1110 |
Prophylaxis - adult |
1,736 |
1,696 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,862 |
2,800 |
$82K |
| D1120 |
Prophylaxis - child |
1,829 |
1,770 |
$66K |
| D0330 |
Panoramic radiographic image |
1,007 |
983 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,484 |
2,438 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,073 |
1,056 |
$22K |
| D1206 |
Topical application of fluoride varnish |
567 |
547 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
285 |
266 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
64 |
$6K |
| D1351 |
Sealant - per tooth |
105 |
40 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
17 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
64 |
52 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
127 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
129 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
114 |
112 |
$1K |