| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,220 |
2,973 |
$525K |
| D1120 |
Prophylaxis - child |
5,256 |
5,213 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
6,927 |
6,851 |
$145K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
821 |
556 |
$108K |
| D1110 |
Prophylaxis - adult |
2,326 |
2,290 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,113 |
3,080 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,276 |
2,921 |
$87K |
| D0330 |
Panoramic radiographic image |
1,754 |
1,752 |
$83K |
| D1206 |
Topical application of fluoride varnish |
5,039 |
4,962 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,287 |
912 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
804 |
473 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,696 |
2,696 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,048 |
1,035 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,640 |
1,640 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,778 |
1,705 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
692 |
692 |
$21K |
| D1351 |
Sealant - per tooth |
555 |
198 |
$13K |