| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,870 |
1,040 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
5,751 |
5,704 |
$149K |
| D1351 |
Sealant - per tooth |
5,301 |
1,299 |
$147K |
| D1120 |
Prophylaxis - child |
4,245 |
4,196 |
$116K |
| D1206 |
Topical application of fluoride varnish |
6,522 |
6,437 |
$105K |
| D1110 |
Prophylaxis - adult |
2,424 |
2,401 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,849 |
1,734 |
$80K |
| D0330 |
Panoramic radiographic image |
1,112 |
1,101 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
423 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,493 |
1,483 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,405 |
2,374 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
837 |
817 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
589 |
574 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
733 |
699 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
151 |
82 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
15 |
$532.14 |