| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,101 |
494 |
$79K |
| D1120 |
Prophylaxis - child |
2,177 |
2,041 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,910 |
2,744 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,334 |
3,130 |
$46K |
| D1110 |
Prophylaxis - adult |
1,272 |
1,162 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
670 |
304 |
$40K |
| D0330 |
Panoramic radiographic image |
773 |
661 |
$31K |
| D1999 |
|
1,535 |
1,484 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,078 |
760 |
$20K |
| D0240 |
|
1,162 |
544 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
810 |
695 |
$19K |
| D0272 |
Bitewings - two radiographic images |
826 |
760 |
$14K |
| D0274 |
Bitewings - four radiographic images |
466 |
406 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
52 |
$7K |
| D1351 |
Sealant - per tooth |
130 |
40 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
47 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
13 |
$127.05 |