| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,097 |
2,099 |
$341K |
| D1120 |
Prophylaxis - child |
8,259 |
7,954 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
8,956 |
8,621 |
$178K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,339 |
9,895 |
$155K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,699 |
4,918 |
$132K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,347 |
965 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,591 |
847 |
$91K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
973 |
630 |
$75K |
| D0272 |
Bitewings - two radiographic images |
3,963 |
3,802 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
512 |
380 |
$53K |
| D0330 |
Panoramic radiographic image |
1,094 |
1,031 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,936 |
1,725 |
$44K |
| D1110 |
Prophylaxis - adult |
813 |
767 |
$33K |
| D1999 |
|
1,890 |
1,104 |
$26K |
| D2335 |
|
102 |
57 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,016 |
901 |
$10K |
| D1351 |
Sealant - per tooth |
217 |
87 |
$5K |
| D2394 |
|
18 |
13 |
$2K |
| D2332 |
|
16 |
12 |
$1K |
| D2330 |
|
18 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$943.95 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$372.00 |