| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,064 |
2,012 |
$397K |
| D1120 |
Prophylaxis - child |
4,426 |
4,409 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
4,753 |
4,732 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,502 |
948 |
$104K |
| D1110 |
Prophylaxis - adult |
1,989 |
1,976 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,010 |
377 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,278 |
3,261 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
518 |
365 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,022 |
2,019 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,765 |
2,686 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
641 |
637 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
714 |
689 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,953 |
2,738 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,344 |
1,740 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
131 |
100 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
294 |
280 |
$4K |
| D9420 |
|
30 |
27 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$2K |