| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,067 |
598 |
$129K |
| D1120 |
Prophylaxis - child |
2,947 |
2,884 |
$126K |
| D1206 |
Topical application of fluoride varnish |
4,216 |
4,126 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,335 |
3,257 |
$97K |
| D1351 |
Sealant - per tooth |
2,875 |
701 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
798 |
474 |
$73K |
| D1110 |
Prophylaxis - adult |
822 |
808 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,213 |
1,187 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
384 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,085 |
956 |
$19K |
| D1330 |
|
2,235 |
2,176 |
$13K |
| D0272 |
Bitewings - two radiographic images |
570 |
559 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
457 |
442 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
50 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
71 |
$1K |