| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,591 |
905 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
3,815 |
3,759 |
$101K |
| D1110 |
Prophylaxis - adult |
2,093 |
2,047 |
$95K |
| D1120 |
Prophylaxis - child |
2,210 |
2,171 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,090 |
1,766 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,537 |
2,488 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
412 |
243 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,980 |
1,947 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,516 |
2,449 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,141 |
2,064 |
$25K |
| D1206 |
Topical application of fluoride varnish |
380 |
366 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
107 |
97 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
61 |
$4K |
| D1351 |
Sealant - per tooth |
128 |
44 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
84 |
$1K |