| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,335 |
2,307 |
$366K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,584 |
1,938 |
$256K |
| D1110 |
Prophylaxis - adult |
3,757 |
3,732 |
$150K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,575 |
924 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
4,027 |
4,005 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,275 |
5,241 |
$91K |
| D9630 |
|
1,729 |
1,696 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,498 |
1,489 |
$55K |
| D0274 |
Bitewings - four radiographic images |
3,120 |
3,099 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,865 |
3,834 |
$42K |
| D1120 |
Prophylaxis - child |
1,761 |
1,754 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
4,472 |
4,373 |
$37K |
| D1351 |
Sealant - per tooth |
1,220 |
410 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
53 |
43 |
$29K |
| D2332 |
|
199 |
96 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
697 |
680 |
$15K |
| D1999 |
|
874 |
602 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
222 |
157 |
$6K |
| D2931 |
|
60 |
49 |
$5K |
| D0272 |
Bitewings - two radiographic images |
436 |
433 |
$4K |
| D0460 |
|
289 |
281 |
$1K |
| D2330 |
|
23 |
12 |
$1K |