| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,939 |
1,729 |
$328K |
| D1120 |
Prophylaxis - child |
17,663 |
11,811 |
$326K |
| D0120 |
Periodic oral evaluation - established patient |
8,018 |
6,295 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,989 |
5,360 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,599 |
7,663 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,860 |
987 |
$118K |
| D0272 |
Bitewings - two radiographic images |
7,482 |
5,069 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,315 |
638 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,901 |
2,217 |
$56K |
| D0330 |
Panoramic radiographic image |
889 |
680 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,942 |
2,698 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,723 |
1,279 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
254 |
206 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D2331 |
|
19 |
12 |
$1K |
| D2330 |
|
19 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$614.52 |