| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,187 |
680 |
$87K |
| D1110 |
Prophylaxis - adult |
1,503 |
1,497 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,116 |
2,106 |
$44K |
| D1120 |
Prophylaxis - child |
1,252 |
1,245 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,606 |
1,601 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,364 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,000 |
851 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
841 |
834 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,402 |
1,336 |
$16K |
| D0330 |
Panoramic radiographic image |
415 |
413 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,732 |
936 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
175 |
132 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
429 |
423 |
$10K |
| D1351 |
Sealant - per tooth |
275 |
73 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
45 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
291 |
291 |
$6K |
| D0272 |
Bitewings - two radiographic images |
327 |
325 |
$6K |
| D1999 |
|
1,529 |
1,382 |
$0.00 |
| D1330 |
|
691 |
687 |
$0.00 |
| D1310 |
|
82 |
82 |
$0.00 |